Preventive Services Under Medicare Advantage Plans
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Preventative care services are important for everyone, especially seniors. The risk for health problems increases with age, and by preventing problems or identifying them early, seniors can enjoy longer, healthier lives. Some preventative services that are particularly important for older adults include annual wellness exams, influenza and pneumococcal vaccines, and screenings for diabetes, high blood pressure, cholesterol, osteoporosis and certain cancers.
Medicare Advantage plans provide coverage for preventative care services, though coverage details vary widely from one plan to another. Before enrolling in a plan, seniors should understand a plans preventative care coverage details, particularly if they are at an increased risk for developing conditions like high blood pressure or osteoporosis.
In this guide, weve outlined how Medicare Advantage plans work, how to know what a Medicare Advantage plan covers and some of seniors most frequently asked questions about their healthcare coverage through Medicare Advantage.
Original Medicare And Acupuncture
Original Medicare is split into parts, which each cover specific services. Medicare Part A pays much of the cost of hospitalization and inpatient care, while Part D is the Medicare prescription drug benefit. Part B picks up much of the rest, including outpatient treatments such as acupuncture and other alternative treatments.
Part B, like the rest of Original Medicare, only provides coverage for treatments it deems medically necessary. Unfortunately, Original Medicare only authorizes acupuncture for lower back pain. Beneficiaries diagnosed with chronic back pain can get up to 12 acupuncture treatments in a 90-day period. Treatment can be extended by up to eight additional sessions if some improvement is shown. Original Medicare benefits are limited to a maximum of 20 sessions per year, or less if the condition worsens.
Applied Behavior Analysis Medical Necessity Guide
The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered for a particular member. The member’s benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
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Choosing A Medicare Plan
If you have chronic low back pain, finding out you can get acupuncture covered by Medicare can be a huge benefit. You may be able to get some relief for your pain without having to spend hundreds of dollars on treatments up to 20 of your sessions will be covered by Medicare.
If you have another health condition you and your doctor think would benefit from acupuncture, unfortunately, Medicare wont cover your sessions. But you may be able to get coverage if you enroll in a Medicare Advantage plan instead.
You can use the Medicare plan finder to shop for plans, compare benefits, and review costs. Many Medicare Advantage plans have $0 monthly premiums, so they can be an affordable option.
How Will Medicare Approve My Acupuncture Treatment
Your acupuncture treatments must be provided by a health care provider. This may include a doctor, physician assistant or nurse practitioner who meets the following criteria:
- Health care provider with a doctorate or masters level degree in Oriental Medicine or acupuncture from an accredited school by the Accreditation Commission on Acupuncture and Oriental Medicine
- A health care provider with an active, unrestricted, full, and current license to practice acupuncture in the state where treatment will be provided
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Is The Annual Wellness Visit The Same As An Annual Physical Exam
Just remember that your annual wellness visit is not a physical exam. If youre confused, dont worry! An annual physical exam may be more extensive than an annual wellness visit. When thinking about the differences, think of the word physical. Your annual wellness visit includes assessments, but the provider doesnt physically touch you, unless you have a specific diagnosis or symptom. The idea is to paint a picture of your health and create a plan for your future care. Your annual physical includes a physical exam, and your provider will check your weight, height, and body mass index .
Does A Medicare Advantage Plan Also Cover Acupuncture
Some Medicare Advantage Plans have been covering acupunctureprior to the new regulations. But not all.
With this new regulation, Medicare Advantage Plans, also called MA plans, MAPD plans, or Medicare Part C, must also cover acupuncture treatment of lower back pain. Medicare Advantage plans provide the same level of coverage as traditional Medicare, including the same procedures and medical treatments. Therefore, Medicare Advantage will also cover acupuncture for lower back pain.
Keep in mind that some Medicare Advantage plans may provide expanded acupuncture coverage to treat other conditions. Medicare Advantage Plans can offer benefits that are richer than what original Medicare might pay. But, read your plan because you might still have to pay a deductible or copay when you receive acupuncture treatment.
And dont forget that if you are in a Medicare Advantage Plan you may need to use in-network providers.
Would you like an appointment to review your plan?
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Are All Acupuncture Services Covered By Medicare
While Medicare pays for some acupuncture services, not all acupuncture sessions are covered.
Acupuncture is covered by Medicare Part B . Its only covered to treat chronic lower back pain. To qualify, you must meet these requirements:
- Your pain has to have existed for 12 weeks or longer.
- There’s no identifiable cause, such as an infectious disease or inflammation.
- Your pain isn’t related to surgery or pregnancy.
Medicare will cover up to 12 acupuncture visits in 90 days. If you show improvement, it will cover up to eight additional sessions, but you cant get more than 20 covered sessions in a year.
According to the CMS, to get Medicare coverage for your pain treatments, acupuncture must be administered by a doctor or healthcare provider with the following qualifications:
- A master’s or doctoral degree in acupuncture or Oriental medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
- A current, full, active, and unrestricted license to practice acupuncture in the state where youre getting treatment
Welcome To Medicare Visits
- Medicare Part B, as well as Medicare Advantage health plans, encourages you to schedule a one-time, Welcome to Medicare preventive visit with your provider within the first 12 months of becoming Medicare-eligible.
- The visit includes a thorough review of your health, as well as education and counseling about preventive services you may need screenings, vaccines, and referrals for other care.
- While not mandatory, this visit is useful for new Medicare beneficiaries to review your current healthcare status and to identify any services that may be necessary to keep you healthy.
- This visit requires specific paperwork be completed before the visit so that you and your provider can review the details together. A limited hands-on examination may be performed, but the real focus of this visit is for you and your provider to discuss a comprehensive review of your health.
For patients with Medicare Advantage health plans, both a traditional Physical Exam and the Welcome to Medicare Visit may be covered benefits. Check with your health plan for eligibility. If you wish to change your currently scheduled annual Physical Exam to a Welcome to Medicare Visit, or to combine visit types in a single appointment, please contact your doctors office as soon as possible. Please be aware that changing the appointment type could result in a date or time change of your upcoming appointment.
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Ama Disclaimer Of Warranties And Liabilities
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Does Medicare Cover Hearing Aids
This content is researched and written independently of the views or opinions of Everyday Health’s editorial team. Everyday Health may earn a commission from purchases of featured products in this article.
If youre wondering how you can afford the best hearing aids that fit your needs, there are probably more options available than you realize. The cost of hearing aids are expensive, and, according to the Hearing Loss Association of America, hearing loss affects approximately 48 million Americans. This makes questions about the cost and payment options for hearing aids critical. Here are a few of the key topics to consider when youre shopping for hearing aids and coverage options from providers like Medicare:
- Does Medicare pay for hearing aids?
- What is the difference in coverage among different Medicare plans?
- What other options are available to cover the cost of hearing aids?
Learn more about some of the options available to help you pay for hearing aids below.
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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
Find Affordable Medicare Supplement Plans
Does Medicare cover acupuncture treatments? Yes!
On January 21, 2020, the Centers for Medicare & Medicaid Services gave notice that acupuncture treatments will be covered to help with chronic low back pain. This is great news for anyone who suffers from chronic low back pain and is looking for an alternative medication painkillers.
In this article well discuss:
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Find Cheap Medicare Plans In Your Area
Acupuncture is covered by two types of Medicare insurance plans Original Medicare and Medicare Advantage along with Medicare Supplement policies. Medicare limits the number of acupuncture sessions you can receive and who can provide those services.
When comparing how each option covers acupuncture, we found that Medicare Advantage generally offers lower cost plans with the same or better coverage than Original Medicare. This makes Medicare Advantage plans particularly HMOs our choice for best overall value.
Medicare covers acupuncture only for chronic low back pain, which the agency defines as:
- Pain not associated with surgery or pregnancy
- Having no known cause
- Lasting 12 weeks or longer
You are covered for up to 12 acupuncture visits in 90 days. Medicare will cover eight additional sessions if you show improvement, which means you can receive up to 20 acupuncture treatments in a calendar year. If your doctor decides the treatment is not helping or your condition is getting worse, Medicare won’t cover the extra acupuncture services.
Remember that Medicare doesn’t cover acupuncture for any condition other than chronic low back pain.
Planning For The Future
Your Medicare Annual Wellness Visit also includes a variety of planning services.
- A written schedule or checklist of recommended preventive screenings for the next 5 to 10 years
- List of immunizations recommended by your doctor
- Advance care planning services, including advance directives, identifying who you want to serve as caregiver should the need arise, the level of care you prefer, and how to have these conversations with your loved ones
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What Are The Benefits Of Acupuncture
Acupuncture is most well documented for its effective pain treatment. Studies have shown that acupuncture can help relieve back pain, neck pain, shoulder pain, and chronic headaches. Many studies postulate that acupuncture is useful for any chronic pain condition, even pain associated with degenerative diseases like osteoporosis.
Another benefit of acupuncture is that it helps Medicare beneficiaries avoid taking painkillers. This helps an individual save on the costs of prescription drug coverage and side effects of prescription drug treatments, but it also means fewer people will be prescribed opioids.
According to members of the Trump Administration, a significant reason behind this expansion of coverage is in response to the opioid crisis.
How Much Does Acupuncture Cost
Acupuncture costs can vary according to your provider and where you live. Your first appointment may be the most expensive, as you will need to pay for the consultation fee as well as any treatment.
Medicare has not yet issued the amount they will pay for acupuncture treatment. Once this approved fee has been established, if you have Medicare Part B, you will be responsible for 20 percent of that fee and your Part B deductible.
Without Medicare, you may expect to pay $100 or more for the initial treatment and between $50 and $75 for treatments after that. A small study done in 2015 averaged the monthly cost of people using acupuncture for lower back pain for one month and estimated it to be $146.
Because rates can vary, ask your practitioner how much your session will cost. Get an estimate in writing, if you can, before you agree to be treated by your chosen acupuncture provider. To be covered by Medicare, any acupuncture practitioner must meet Medicare requirements and agree to accept Medicare payment.
While Medicare doesnât cover most alternative therapies, you may be covered for some alternative treatments under specific circumstances.
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Acupuncture And Medical Conditions
Medicare aims to cover treatments that are medically necessary, and acupuncture remains a controversial procedure. Acupuncture is an ancient Chinese practice where small needles are inserted into certain areas in the skin to stimulate responses in certain areas of the body. The exact mechanism for how it works is unknown, though it is theorized that neurohormonal pathways may play a part.
To date, acupuncture has been used to treat a number of conditions including allergic rhinitis, depression, fibromyalgia, headache, hypertension, migraine headaches, nausea, and numerous pain syndromes ranging from low back pain to rheumatoid arthritis.
What Are The Limits On Medicare Acupuncture Coverage
Medicare will cover up to 12 visits in 90 days, plus an additional eight visits if youre improving. If your doctor thinks your back pain isnt getting better or is getting worse, Medicare wont cover those additional eight visits. Medicare will cover no more than 20 acupuncture treatments in a year.
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What Is Included In The Welcome To Medicare Visit
Your Welcome to Medicare preventive visit is a one-time visit that is covered by Medicare Part B within first 12 months that you are enrolled in Medicare Part B.
During your Welcome to Medicare visit, you and your doctor will review your medical history, which may include:
- Height, weight and blood pressure measurements
- A simple vision test
- Certain screenings
- Flu and pneumococcal shots
If you doctor accepts Medicare assignment, you typically pay nothing for your Welcome to Medicare visit.
If your doctor performs additional services or tests during your Welcome to Medicare visit that arent covered under the preventive benefits of Medicare Part B, you may have to pay a 20 percent Part B coinsurance .
If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare Part B, your Medicare Advantage plan will cover your Welcome to Medicare visit within the first 12 months that you have the plan.
You must visit a doctor who is in your plans provider network.
If you have a Medicare Advantage plan, your coinsurance and deductible costs may vary. If a service is fully covered by Medicare Part B, it will be fully covered by your Medicare Advantage plan.