Saturday, November 26, 2022

Does Aetna Medicare Advantage Cover Acupuncture

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Health Maintenance Organization Plans

Medicare Advantage Plans Explained (2022)

HMO plans are by far the most popular form of Medicare Advantage coverage because all services offered by the network are generally covered by the insurance. An HMO network that offers acupuncture should also have a corresponding insurance plan that pays for it, though only a member services representative can definitively say which plan does.

Does Medicare Advantage Cover Alternative Holistic Or Osteopathic Medicine

Alternative therapies such as acupuncture, chiropractic care, and massage are becoming more popular among Americans. Research into these methods is mixed and evolving. For the people who gain relief through alternative medicine, though, the benefits are real regardless of what the research says.

But does Medicare Advantage cover alternative medicine? The answer varies by both plan and treatment. In 2018, new legislation expanded access to complementary, holistic, and osteopathic medicine for Medicare Advantage recipients. But if you’re interested in accessing alternative medicine through Medicare Advantage, the specific coverage for which you are eligible depends on the plan you choose.

Acupuncture Coverage Under Medicare

During an acupuncture procedure, a practitioner penetrates a patients skin with fine needles that are placed at strategic areas. This practice is believed to balance blood flow and stimulate nerves and connective tissue.

As of publication, the only official health condition that Medicare covers acupuncture treatment for one is chronic lower back pain. In fact, the U.S. Centers for Medicare and Medicaid Services only recently introduced this new benefit at the start of 2020. Now, under Medicare Part B, acupuncture services performed on or after January 21, 2020 are covered.

Medicare Part B is one of the core parts of Original Medicare.

  • Medicare Part A covers hospital costs, including inpatient care, lab tests, surgery, and other services.
  • Medicare Part B covers basic medical insurance needs, such as doctor visits and outpatient care.

Regarding acupuncture specifically, its coverage falls under Medicare Part B because the service is an outpatient hospital service performed by a physician.

The decision to include acupuncture in Part B coverage is part of a larger effort to incentivize non-pharmacological forms of pain management. This is particularly relevant information for those suffering from lower back pain, given that the condition is one of the most common reasons why patients are prescribed opioids.

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Medicare Advantage Coverage For Alternative Medicine

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Since the law changed in 2018, Medicare Advantage plans have offered more supplemental benefits. In 2018, 11% of plans covered acupuncture, but by 2020, the figure was 20%. Almost all plans now cover some fitness benefits, and many cover:

  • Home modifications
  • In-home support, such as a home health aide
  • Nutrition consultations

You may have to meet certain eligibility criteria or hit a deductible before coverage kicks in. For people who need a wide range of complementary services, though, these benefits offer significant savings. Moreover, such benefits may encourage people to consider complementary care they might not otherwise have used. This could improve their healthâespecially when complementary care encourages more exercise or a better diet.

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How Can I Make A Same

On average, patients who use Zocdoc can search for an Acupuncturist who takes Aetna insurance, book an appointment, and see the Acupuncturist within 24 hours. Same-day appointments are often available, you can search for real-time availability of Acupuncturists who accept Aetna insurance and make an appointment online.

Does Accurate Acupuncture Accept Insurance

Yes, we accept most major insurance. We are an in-network provider for United Healthcare, Aetna, and Healthnet. We also accept Blue Cross Blue Shield, Cigna, and Banner Health Choice Plus.

Call us at and well help verify your coverage. And if you have a Medicare Supplement plan, please let us know to ensure proper billing.

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Medicare Coverage For Acupuncture

Original Medicare covers inpatient and outpatient care that is deemed medically necessary. Under current guidelines, Medicare does not consider acupuncture to be medically necessary, so if you decide to get it, youll have to pay for the treatment out-of-pocket.

According to the Centers for Medicare & Medicaid Services , Although acupuncture has been used for thousands of years in China and for decades in parts of Europe, it is a new agent of unknown use and efficacy in the United States. Even in those areas of the world where it has been widely used, its mechanism is not known.

As a result, Medicare will not reimburse for acupuncture treatments until more scientific studies have been completed into the safety and effectiveness of the practice.

This doesnt mean that Medicare wont cover treatment for your condition. You may be covered for other forms of treatment for your symptoms, such as physical or occupational therapy. But if you decide to get an acupuncture treatment, even with a doctors recommendation, you wont be covered for it under Original Medicare.

While thats disappointing, the good news is that acupuncture treatments may be covered under some Medicare Advantage policies, which well look at later in this article.

Duration Of Acupuncture Treatment Covered By Medicare

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Medicare Part B plans will cover up to 12 visits in 90 days for the treatment of chronic lower back pain, which meets the following criteria:

  • Lasts 12 weeks or longer
  • Cannot be the result of another condition, whether inflammatory, infectious or related to any other kind of disease
  • Is not induced by post-surgery pain
  • Is not caused by pregnancy

If a patient improves after 12 acupuncture sessions over the course of three months, Medicare Part B will cover another eight sessions for a total of up to 20 sessions in a year. The Centers for Medicare and Medicaid Services requires treatment to stop if the patient does not improve after this initial time frame.

If a patient improves after 12 acupuncture sessions over the course of three months, Medicare Part B will cover another eight sessions for a total of up to 20 sessions in a year.

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Plans That Might Have Acupuncture Coverage

  • Horizon BCBS NJ Direct

Since health insurance coverage varies from plan to plan, please contact our office with your insurance information for more details.

11991199 mostly has plans that cover acupuncture treatment at 100% with 25 visits per calendar year. The patient may be responsible for a co-pay for their initial visit. Please call our office with your insurance information to find out benefit coverage. CARECONNECTCareconnect has plans that do and do not cover acupuncture treatment. The patient may be responsible for a co-pay or coinsurance. Many of the plans require authorization for treatment. Please call our office with your insurance information to find out benefit coverage.
THE EMPIRE PLAN The Empire Plan covers acupuncture treatment at 100% after a $20 co-pay. There are no visit limits for this plan. The ID number of the card must begin with 890. Please call our office with your insurance information to find out benefit coverage. BLUE CROSS BLUE SHIELDBlue Cross Blue Shield has many plans that cover acupuncture with either a co-pay or coinsurance. Some plans may be limited to a number of visits per calendar year. Please call our office with your insurance information to find out benefit coverage.

CIGNAGHI, HIP, OXFORD, MEDIBLUE, MEDICARE, MEDICARE SUPPLEMENT PLANS NO-FAULT If your insurance is not listed, please call our office or fill out the form below.

Finding A Medicare Advantage Plan That Covers Acupuncture

Since Medicare Advantage policies are provided by private insurers, Medicare Advantage plans vary from state to state, so the details of plans offered in Massachusetts are likely to differ from those available in California, Texas and Florida. In spite of this, Medicare Advantage plans do have some details in common. Most are organized as health maintenance organizations, preferred provider organizations, private fee-for-service or special needs plans. Some of these plans are more likely to cover alternative therapies than others, although it may take some research to find a state-specific plan that has the necessary coverage.

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How To Get Covered For Acupuncture

If youre already paying for acupuncture or chiropractic treatments out-of-pocket, or suspect you may need them in the future, then look for a Medicare Advantage plan that covers them. Paying a higher monthly premium may be worth it if you expect to use these treatments regularly.

You have more flexibility to switch between Medicare Advantage plans that you do with Original Medicare and Medigap, so be sure to check your coverage each year to find out if its changed or if another plan offers more extensive coverage.

If you want to switch to a plan that covers acupuncture or chiropractic care, you can only do that during the Open Enrollment Period, which takes place twice per year.

Another option is to see if these services will be covered by any secondary insurance you have, such as a spouses insurance plan or by federal employee health coverage.

How Much Does Medicare Pay For Acupuncture

ACUPUNCTURE

Medicare pays 80% of the approved amount for your acupuncture services. If Original Medicare is your only coverage, you’ll pay the remaining 20% after meeting your deductible.

Say your acupuncture provider typically charges $200 for an acupuncture treatment. But the provider signed an agreement to accept Medicare’s approved amount for the service, or $100. After Medicare pays its portion, you pay the balance of 20%, or $20.

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Find Medicare Advantage Plans That Cover Acupuncture

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

The purpose of this communication is the solicitation of insurance. Callers will be directed to a licensed insurance agent with TZ Insurance Solutions LLC, TruBridge, Inc. and/or a third-party partner who can provide more information about Medicare Advantage Plans offered by one or several Medicare-contracted carrier. TZ Insurance Solutions LLC, TruBridge, Inc., and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

What Is The Process Of An Acupuncture Treatment

During an acupuncture session, small needles are strategically placed on different points of the body believed to be directly correlated with the body’s internal energy channels to help stimulate and balance the energy flow. Individuals generally receive treatment laying down on ergonomically designed tables.

Those receiving treatment are instructed not to move while the needles are inserted, and the process takes between 30 minutes and an hour to complete. In addition to acupuncture needles, some practitioners use heat, electromagnetic energy impulses, friction or suction/cupping techniques. It’s important to note that acupuncture can affect everyone differently, and while some individuals may experience positive results after their first treatment session, others may require multiple sessions before healing takes place.

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Is Acupuncture Covered By Medicare

As of January 2020, Medicare covers acupuncture treatment for chronic low back pain, according to the Centers for Medicare & Medicaid Services.1 The coverage is subject to limitations on the number of sessions and the type of provider administering the treatment.2

Heres a deeper look into acupuncture and Medicare.

How To Choose A Plan

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While many Medicare Advantage plans cover some forms of alternative medicine, each plan establishes its own rules for this coverage. When shopping for a plan, begin by identifying your holistic care needs. A plan that covers a wide range of complementary medicine might not be right for you if it does not cover the specific alternative care you want. When you compare plans, some things to focus on include:

  • The specific complementary care the plan covers, as well as the deductible
  • Whether you have to get a referral or meet other criteria to qualify for alternative care
  • Which providers you can seek alternative care from. You might have to switch acupuncturists or find a new massage therapist.
  • The out-of-pocket maximum, premium, and deductible associated with each plan
  • The plan structure. A health maintenance organization may save you money, but limits the providers you can see, while a special needs plan might be a good choice if you have a chronic condition.

To maximize your savings, tally up your out-of-pocket expenses from last year, including complementary care. Then calculate how much you would save on alternative care with a plan that covered it. Make sure to account for deductibles and additional premiums. If you’ll save moneyâand still get coverage for all of the other care you needâthen a Medicare Advantage plan, even a more expensive one, may be a sound bet.

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How Does Acupuncture Work For Back Pain

Acupuncture is a traditional Chinese medicine practice that practitioners have used for thousands of years to relieve pain and promote wellness. To perform the technique, a trained professional applies tiny needles to specific areas of the body to induce energy flow and relieve pain.

This process can trigger the release of pain-relieving chemicals that occur naturally in the body. Imaging studies of peoples brains when they receive acupuncture have found that the method helps quiet down overactive pain sensors.

The effects of acupuncture on chronic pain can be long lasting. In a review of 29 clinical trials involving people with headaches or pain in the lower back, neck, shoulder, or knee, an estimated 90% of the 17,922 participants reported pain relief lasting at least 12 months after their acupuncture treatments.

In addition, the technique does not usually cause significant side effects, with the most common being pain and bleeding at the needle insertion site.

Acupuncture professionals use acupuncture to treat a variety of medical conditions. The authors of a 2019 article estimated that around 37,000 licensed acupuncturists currently practice in the United States.

According to the American Academy of Medical Acupuncture, acupuncture can help relieve symptoms of the following conditions:

  • gynecological disorders

Benefits Of Acupuncture Treatment

Acupunctures roots can be traced back to traditional Chinese medicine, which is a system of health care delivery techniques that include tai chi and the utilization of herbal medicines to address ailments.

Acupuncture is one of many alternative forms of pain management available, and it is becoming increasingly popular in Western medicine. One of acupunctures most popular applications is as a non-pharmacological method for relieving stress and anxiety.

But there are many more additional areas where acupuncture has proven beneficial, including the treatment of:

  • Back and neck pain
  • Menstrual cramps and other symptoms
  • Mental health and sleep disorders
  • Nausea and morning sickness
  • Reducing the side effects of chemotherapy, including nausea

If youre a Medicare Part B member and have chronic lower back pain, your insurance plan will cover up to 12 visits to an acupuncture practitioner. Before setting up an appointment, we suggest researching the practitioners in your area and reading reviews to see others experience with the service.

If you dont have Medicare Part B but still want acupuncture coverage, you can find a private Medicare Advantage plan that offers it as a benefit to members. Contact the provider to confirm it is covered first.

AgingInPlace.org keeps our resources free by working as an affiliate partnerwith some companies mentioned on our site. We may earn a commission when you click on certain product links.

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Aetna Medicare Reviews And Ratings

Each year, the Centers for Medicare & Medicaid Services evaluates Medicare Advantage plans using a five-star rating scale. Aetna Medicare Advantage Prescription Drug plans earned an overall rating of 4.29 stars out of five for 2022, placing it above average versus the competition.

Not all types of plans are available in all areas. You can speak with a licensed insurance agent to find out what plans are offered in your area.

For more information, please visit www.aetna-medicareadvantage.com.

How Can I Book An Appointment Online With An Aetna Acupuncturist

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Zocdoc is a free online service that helps patients find Aetna Acupuncturists and book appointments instantly. You can search for Aetna Acupuncturists by symptom or visit reason. Then, choose your location. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

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