Does Unitedhealthcare Cover Acupuncture
UnitedHealthcare Medicare Advantage plans cover acupuncture only for chronic lower back pain, defined as pain lasting at least 12 weeks.
The pain must not result from pregnancy, surgery or another health condition. Members who meet the criteria can receive coverage for up to 12 visits in 90 days. If the treatment improves the person’s back pain, the company will cover another eight acupuncture sessions for a total limit of 20 in 12 months.
Visit MedicareAdvantage.com to find out if a UnitedHealthcare plan available in your area covers acupuncture.
What Type Of Conditions Can You Get Medicare Coverage For Acupuncture
As mentioned above Medicare Part B and Supplemental plans only cover Acupuncture for low back pain.
Medicare Advantage plans and Medicare Part C plans have broader range of coverage and vary by plan. The only way to confirm coverage is to review your plan documents or call your health insurance company. These plans are very similar to commercial health insurance plans. In order to be assured coverage, you will need to confirm that your plan has an Acupuncture benefit and that your plan covers Acupuncture for the condition you are seeking help with. A third factor related to coverage: Is your provider in-network for out of network?
This a complicated topic and I wrote a separate blog post on Acupuncture Insurance Coverage here.
Finding An Acupuncture Provider With Medicare
In addition to making sure that your condition qualifies for coverage, you must also use a provider that Medicare covers. Not all acupuncture providers will meet the requirement. Your treatments must be provided by a doctor or another health care provider, like a nurse practitioner or physicians assistant. Next, your provider must have the following two essentials:
- A masters or doctoral level 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 care
If your provider does not possess the two qualifications above, then Original Medicare will not provide coverage. Note that your provider must be a licensed acupuncturist. Not all doctors will possess a license to practice acupuncture, so you will need to search for providers in your area who meet these requirements. When making your appointment, you should go ahead and ask the provider whether they will accept Medicare. While they might accept plans from other insurance companies, you will want to ensure that your provider will accept Medicare. Otherwise, you might find yourself attempting to get reimbursed from Medicare after you pay the bill in full.
Read Also: Is Kaiser A Good Medicare Advantage Plan
When Does Medicare Cover Acupuncture
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, 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.
Who Can Perform Acupuncture
Acupuncture treatments taken by licensed acupuncturists cannot be covered through Medicare. This is because Medicare does not accept licensed acupuncturists as a provider. Instead, Medicare wants you to be treated for your back pain by a physician or healthcare provider with a range of certain qualifications. CMS requires doctors to be covered for acupuncture should
- Have a doctoral degree or masters in acupuncture from an accredited school by ACAHM Accreditation Commission for Acupuncture and Herbal Medicine.
- Have an active, full, and unrestricted license in order to practice acupuncture in the state, the commonwealth of the US, and in the territory of the District of Columbia.
- Working as a Medicare provider or have been supervised by a provider accepted by Medicare.
Don’t Miss: Do You Have To Pay A Premium For Medicare
What Providers Qualify For Acupuncture Coverage
To qualify for coverage, the acupuncture must be administered by a doctor or other health care provider, such as a nurse practitioner or physician assistant, who meet both of these criteria:
- A masters or doctoral level degree in acupuncture or Oriental medicine from a school that has accreditation from the Accreditation Commission on Acupuncture and Oriental Medicine.
- A current, full, active and unrestricted license to practice acupuncture in the state or territory where youre receiving care.
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.
Read Also: Does Medicare Cover Laser Surgery
Acupuncture Coverage With Medicare Supplement Plans
Some Medicare beneficiaries choose to sign up for a Medigap plan to help cover out-of-pocket expenses not covered by Original Medicare. So, does Medigap pay for acupuncture services? Remember that you must be enrolled in Original Medicare to be eligible for a Medigap plan. These plans help cover out-of-pocket expenses associated with Medicare, like your deductibles, copays, and coinsurance amounts.
So, it is possible that your Medigap plan might cover the coinsurance amount that is required when you receive acupuncture treatment. The details of these plans vary from one plan to the next, so you should check your plans specifics to determine what it will pay for. Remember that Medigap plans will only help with costs for services that are covered by Medicare. If you receive acupuncture treatment that is not covered by Medicare, your Medigap plan will not pay for it.
Medicare Advantage Coverage For Alternative Medicine
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.
You May Like: How To Call Medicare Gov
Medicare Part C Eligibility
To enroll in a Medicare Part C plan, you must be eligible and meet specific requirements. You must:
- Be enrolled in Original Medicare, both Part A and Part B
- Live within the service area of the insurer and plan you are applying to enroll in
- The plan must be accepting new users.
You must also enroll in Medicare Part C during specific times.
Preferred Provider Organization Plans
PPOs operate with a network of preferred providers, but the plans usually include coverage for beneficiaries who go outside the network for specialist care. If a given Medicare Advantage plan has a preferred network that includes an acupuncture provider, the plan likely includes coverage for that service. PPO participants who wish to go outside their network for acupuncture treatment are likely to have more flexibility than HMO plan participants.
Also Check: What Medicare Plan Covers Dental
What Parts Of Medicare Pay For Acupuncture
Acupuncture for chronic lower back pain is covered under Part B, if a beneficiary has Original Medicare.
Acupuncture for chronic lower-back pain is covered under Medicare Part B for up to 12 visits in 90 days. If your chronic lower-back pain improves, your plan may cover another 8 visits. If your doctor determines your condition is not improving or is getting worse, acupuncture treatments will no longer be covered. There is a limit of 20 acupuncture treatments per year.5
Does Medicare Cover Acupuncture Costs
Medicare began covering acupuncture in January 2020, but only for chronic lower back pain. Medicare Part B covers up to 12 acupuncture visits in 90 days for beneficiaries with the condition. Original Medicare Part A and Part B does not cover acupuncture treatments for any other condition.
-
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education .
-
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
APATurner, T. . Does Medicare Cover Acupuncture Costs? RetireGuide.com. Retrieved September 5, 2022, from https://www.retireguide.com/medicare/treatments/pain-management/acupuncture/
Content created by RetireGuide and sponsored by our partners.
Key Principles
Don’t Miss: What Is The Official Medicare Website
Which Medicare Advantage Plans Offer Acupuncture
Medicare Advantage plans vary by location, not all plans offered are going to cover Acupuncture. But, Humana and UnitedHealthcare both offer plans in select areas with some acupuncture coverage. There may be other carriers that offer this benefit, but it really just depends on the plans available in your service area.
Medigap Vs Medicare Advantage
Medigap and Medicare Advantage plans are two different ways to provide much of the additional healthcare coverage that many people want, but Original Medicare does not provide. Original Medicare covers many basic inpatient or hospital services, and outpatient or doctors offices and preventive care services. But patients must pay the deductibles and up to 20 percent of the total care expenses. Medigap plans are Medicare Supplemental policies that fill in the gaps of Original Medicare.
There are pros and cons to choosing Medigap versus Medicare Advantage. For instance, many select Medigap because:
- You do not need a referral or prior authorization from a doctor
- Your coverage can travel more easily with you within the US to any doctor or facility that accepts Medicare
- Some Medigap plans include some coverage for emergency care while traveling outside of the US.
Other people prefer the benefits of a Medicare Advantage plan. Some of the pros of these plans include:
- Some plans have lower premiums than Medigap plans
- A more convenient way to manage all of your healthcare needs with a single insurer
- Care coverage for dental, vision, hearing, and prescription drugs.
Recommended Reading: What Is Medicare Type A
Why Medicare Advantage Plans Are Bad And Why Dont The Doctors Like Ma
While affordable Medicare Advantage plans are an increasingly popular choice for beneficiaries, not all doctors love the plans. Patients often do not have as much choice in the doctors they can see and may face hurdles to getting to the specialists they need for specific conditions.
Insurers providing affordable Medicare Advantage plans also pay doctors upfront based on the diagnosis of the patient. This method can be risky for the doctor, who can lose money if they do not stay within the budget. And the patient may not get the most appropriate care.
That is why it is very important to check if your preferred doctors are in the network of the Medicare Advantage plan that you are looking to enroll in. You can easily do that using this tool, just enter your zip code and your preferred doctors and check which plans are offered in your area by the top insurance carriers that include your doctors as part of their respective network.
Finally, prior authorizations can be just as frustrating for the doctors as it is for the patients.
When Does Medicare Pay For Acupuncture
Medicare Part B will only pay for acupuncture treatments to treat chronic back pain. It is not covered for any other type of pain or discomfort.
Medicares Definition of Chronic Back Pain
- Back pain lasting 12 weeks or longer.
- Back pain that has no identifiable systemic cause the pain cannot be associated with metastatic, inflammatory or infectious diseases.
- Back pain that is not associated with pregnancy or surgery.
Medicare also only covers acupuncture when it is performed by a doctor or health care provider who has a masters or doctoral degree in acupuncture as well as an unrestricted state license to practice it.
While Medicare typically does not include acupuncture in its covered chiropractic services, you should be covered to receive this care from a chiropractor if it is exclusively to treat chronic lower back pain.
Recommended Reading: When Will I Be Eligible For Medicare
The Disadvantage Of Medicare Advantage Plans
In some situations, a Medicare Advantage plan may not be the best choice for you. For example, although the monthly premium might be lower than a Medigap plan, you could still end up paying more overall if you become ill and must pay copays or coinsurance more frequently.
If you have a Medicare Advantage plan that relies on smaller provider networks, you might also pay more to access the out-of-network care you need. And people in rural areas may struggle to access even more run-of-the-mill care, whereas Original Medicare recipients can go to any provider that accepts Medicare.
When Will Medicare Cover Acupuncture
Acupuncture is covered by Medicare Part B. In order for the acupuncture to be covered, the patient must be experiencing chronic back pain.
Chronic back pain is defined as:
- Pain that has persisted for 12 weeks or longer
- Pain that is not related to cancer, infectious disease, inflammation, pregnancy or surgery
If a beneficiarys lower back pain meets the above guidelines to be classified as chronic pain, Medicare Part B will cover up to 12 session of acupuncture treatment in 90 days. Medicare will then cover an additional eight sessions if the beneficiary shows signs of improvement, for a total of 20 covered sessions. No more than 20 treatments will be covered in the same calendar year.
Also Check: What Is Better Medicaid Or Medicare
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.
Is There A Way To Get Coverage For Alternative Medicine
In addition to Medicare Part A and Medicare Part B, there are additional plans that you can purchase to increase your coverage.
Medicare Part C plans are private insurance plans that provide the benefits of original Medicare combined with options from private insurance companies. Advantage plans must cover services that Medicare Part B covers, so any Medicare Advantage plan must cover acupuncture at least the same as Medicare Part B.
Part C may deny claims for alternative treatments. If you have a Medicare Advantage plan, ask your provider their policy for other alternative medical treatments.
Medigap supplement plans can be purchased to increase the benefits of traditional Medicare coverage. These supplement plans cover things like deductibles and other out-of-pocket medical expenses.
Private insurance plans are the most likely to cover alternative therapies. While the initial cost of private insurance plans may be higher, these plans may reduce costs of alternative therapies.
Read Also: Does Medicare Need Pre Authorization
Duration Of Acupuncture Treatment Covered By Medicare
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.
