Until 2020, Medicare did not offer any coverage for Acupuncture, an alternative Chinese technique based on inserting needles into the body to stimulate specific points. Now Medicare has finally decided to cover Acupuncture.
According to the Center for Medicare Services (CMS), the rise in opioids consumption is one of the key reasons why Acupuncture is now covered. It is expected that this measure will help bring down opioid consumption numbers while providing access to a practice whose primary focus is to calm pain.
How does Medicare cover Acupuncture?
Medicare Part B covers up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare defines chronic low back pain as:
- Lasting 12 weeks or longer
- Having no identifiable systemic cause (not associated with metastatic, inflammatory, or infectious disease)
- Pain that’s not associated with surgery or pregnancy
An additional 8 sessions will be covered if improvement is shown. If your doctor decides your chronic low back pain isn’t improving or is getting worse, then Medicare won’t cover your treatments. Up to 20 acupuncture sessions can be given per year.
Now that Medicare covers Acupuncture, it is a good time to review what is still left without coverage:
- 20% of all your medical costs (Medicare usually pays 80% and you pay 20%)
- Any deductible, copay or coinsurance
- Prescription Drugs
- First 3 pints of blood
- Foreign emergency healthcare
For help getting coverage for these additional issues, give us a call here at Senior65.com at 800-930-7956. There is never a fee for our services and we guarentee the lowest prices by law.
Does Medigap cover Acupuncture?
Medigap is well known for covering the 20% Medicare leaves out but it rarely provides insurance for issues not already covered, in part, by Medicare. Until 2020, there was no Medigap plan that covered Acupuncture since Medicare didn’t cover it. Health Net Innovative G in California has changed that. This plan is part of a new wave of innovative Medigap plans that come with additional hearing and vision benefits. Healthnet’s new plan also adds Acupuncture and Chiropractic care.
Is it worth it to get CA Health Net’s Innovative G just for the acupuncture coverage? Well, it depends. This plan covers 20 visits combined between Acupuncture and Chiropractic services each year. So technically you could use this plan to cover 20 additional acupuncture visits (assuming you didn’t have any visits to your local chiropractor). Learn more about Health Net’s Innovative plan G Medigap here.
Please Note: All other Medigap plans offer no additional coverage for Acupuncture at this time. We will keep you posted if this changes.
Does Medicare Advantage cover Acupuncture?
Medicare Advantage plans replace Original Medicare and are offered by private companies. Since every MA plan works differently, coverage really depends on the insurance carrier you work with. That being said, Acupuncture is not commonly covered by Medicare Advantage. This may change in the future now that Medicare covers some Acupuncture.