Tuesday, September 20, 2022

What Medicare Advantage Plans Cover Acupuncture

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Do Private Medicare Plans Cover Acupuncture

Independence Blue Cross Medicare Advantage acupuncture and chiropractic treatment coverage

While the 2020 ruling allows Original Medicare to cover acupuncture, some Medicare Advantage plans were already covering it.

Medicare Advantage plans may also offer expanded coverage or additional benefits for other services not covered by Original Medicare. So there may be some Medicare Advantage plans that offer acupuncture coverage beyond just the chronic lower back pain coverage that is now found under Part B.

Most Medicare Advantage plans also offer prescription drug coverage, which may include prescriptions to help with chronic pain. Original Medicare doesnt typically cover prescription drugs.

Will My Doctor Accept Medicare For Acupuncture

Medicare will only cover acupuncture when its performed by a doctor or other health care provider who possesses the following credentials:

  • A masters degree or doctorate degree in acupuncture or traditional Asian medicine from a school that is accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
  • An active and unrestricted license to practice acupuncture in the state where the service is being provided

Original Medicare does not cover acupuncture for any other condition besides lower back pain.

Medicare Advantage Plans And Acupuncture

Medicare Advantage plans are meant to supplant Original Medicare Parts A and B, and so theyre required to provide all the same benefits as Part A and Part B as a baseline, with some room to expand services. That means that every Medicare Advantage plan provides the same 12 to 20 acupuncture sessions per year as Original Medicare.

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Does Medicare Cover Chiropractic Care

Medicare does cover medically necessary chiropractic services. According to the CMS, Medicare Part B covers 80% of the cost for manipulation of the spine if medically necessary to correct a subluxation. There is no cap on the number of medically necessary visits to a chiropractor.

Under Original Medicare, without any additional insurance, you would have to pay your part B deductible and 20% coinsurance for all medically necessary chiropractic appointments.

Additional Information About Acupuncture And Medicare

Does Medicare Cover Acupuncture?

Medicare also set guidelines on qualifications your acupuncture provider must meet.

  • Acupuncture treatments must be given by a healthcare provider, such as a doctor, physician assistant, or nurse practitioner
  • The provider must have a master’s or doctoral degree in either acupuncture or Oriental medicine

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Medicare Advantage Coverage Change For Acupuncture

Legislative changes in the Social Security Act now allow for coverage of acupuncture services under MA plans when specific clinical and professional criteria are met.More information can be found at and outlined below under Additional Information.

Blue Cross and Blue Shield of North Carolina does not credential or contract with Acupuncture providers, however, we are asking our participating MA providers to self-report their ability to offer acupuncture services. This will enable us to display on our Find a Doctor portal those participating providers that offer acupuncture services.

If your practice offers acupuncture services, please provide practice information and respond to the questions below via email at .

Practice Information

  • Type 1 or 2 NPI
  • Contact Name and Email
  • Do you have MDs in your practice who perform acupuncture?
  • Do you have Physician Assistants, Nurse Practitioners/Clinical Nurse Specialists who perform acupuncture?
  • Do you have auxiliary personnel such as Acupuncturists or Physical Therapists who perform acupuncture?
  • If yes to either question , please confirm if service provider has A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine and a current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth of the United States, or District of Columbia.
  • Additional Information

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    Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?

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    Acupuncture Services Covered By Medicare

    Original Medicare does not yet cover acupuncture for everyone or for any type of chronic pain. Medicare pays only for people who live with chronic low back pain. This is defined as pain without a systemic cause, and must not be connected to surgery or pregnancy. The pain must have lasted for 12 weeks or longer.

    Also, you must receive this therapy from a healthcare provider with advanced training in acupuncture or Oriental Medicine. The provider must also have a license to perform acupuncture in your state.

    If all of these conditions are met, Medicare will cover 12 acupuncture appointments within 90 days, with an additional 8 covered within that time if your condition gets better. These additional appointments are not paid for by Medicare if your doctor does not think the treatment is improving your back pain.

    Medicare Part B pays for up to a maximum of 20 acupuncture visits per year.

    What Is Medicare Advantage

    Medicare and Acupuncture – Medicare Coverage: Does Medicare Cover Acupuncture?

    Medicare Advantage is a way to get you Medicare Part A and Part B benefits from a private insurance company. When you enroll in a Medicare Advantage plan, youâre still in the Medicare program and are required to pay your Part B premium along with any premium the plan charges. Medicare Advantage plans must cover everything that Original Medicare covers and often offers additional benefits. Some extra benefits covered by Medicare Advantage plans could include routine vision, routine dental, prescription drugs, and routine hearing. Please keep in mind that not all Medicare Advantage plans cover the same services, and benefits may vary by plan.

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    Does Medicare Cover Acupuncture In 2022

    Medicare will cover acupuncture if you have a diagnosis of chronic lower back pain. If you have chronic lower back pain Medicare funds up to 12 sessions of acupuncture treatment within a 90-day window.

    This treatment will cost you 20% of the fee that Medicare approves, these costs are associated with Part B. To continue acupuncture treatments for chronic back pain, your symptoms must show some improvement within the first 12 sessions.

    During a 12-month period, Medicare will only cover a maximum of 20 sessions. Also, Medicare provides a list of approved providers in your area.

    How Else Can Medicaid Beneficiaries Get Help Paying For Acupuncture

    Medicaid beneficiaries who are dual eligible, or eligible for both Medicaid and Medicare, may have the opportunity to enroll in a Dual-eligible Special Needs Plan . A Special Needs Plan is a certain type of Medicare Advantage plan with benefits that are tailored to a specific health condition or circumstance. Dual-eligible Special Needs Plans are designed specifically for those on both Medicaid and Medicare and may include coverage for acupuncture.

    Some Medicaid beneficiaries may also be eligible to enroll in a Medicaid managed care plan. These plans deliver traditional Medicaid benefits along with some additional benefits through a partnership with managed care organizations.

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    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.

    Does Medicare Cover Acupuncture Costs

    Medicare and Acupuncture Coverage

    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/

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    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.

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    Attitudes Toward Acupuncture Changed In The Face Of A Rising Opioid Crisis

    For the longest time, CMS viewed acupuncture as a sort of placebo treatment. Following the lead of American medical researchers, they saw no real benefit to acupuncture, and the treatment was primarily seen as a fad that created the illusion of a miracle cure for patients seeking fast, easy pain relief. As the 20th century came to an end, that attitude would slightly change.

    Well, for much of the healthcare industry, at least.

    In 1997, the National Institutes of Health conducted studies that showed acupuncture to be an effective treatment for not only chronic pain, but symptoms of other illnesses, diseases, and treatments as well. For example, it was viewed as highly effective for easing nausea in chemotherapy patients. Despite this research, CMS would not move from their position on the treatment, continuing to view it as ineffective and not medically necessary.

    That is, until the issue of the opioid crisis would force CMS to budge. For decades, opioid medications were the primary go-to in Western medicine for pain relief. Despite research that proved opioids to be rather ineffective in treating chronic pain, many doctors continued prescribing these medications. As opioid use grew, so did the epidemic of opioid addiction.

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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 With Medicare

    Medicare Acupuncture is Now Covered | New Changes

    To find out how much your treatments will cost, you should talk to your health care provider and Medicare plan provider before scheduling your services. Your total costs may vary based on things like how much your health care provider charges, other insurance you may have, or whether your health care provider accepts assignment.

    NOTE: Acupuncture coverage for cLBP was added to Medicare Part B plans as of January 21, 2020, and treatments completed prior to that date may not be covered.

    Read Also: Do You Need Medicare Part B To Get Part D

    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.

    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.

    Recommended Reading: What Is Medicare Managed Care

    How Original Medicare Approaches Acupuncture

    The Centers for Medicare & Medicaid Services confirmed in January 2020 that Medicare Part B will cover some acupuncture for people with chronic low back pain. The CMS explained its decision by saying it had a mandate to offer different pain treatment options to patients. These include alternatives to prescription pain medications.

    How Much Does Acupuncture Cost

    Is Acupuncture Covered by Medicare

    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 was previously not covered by Medicare under any circumstances. The recent decision to offer Medicare coverage for acupuncture only applies to treatment of chronic lower back pain. Chronic back pain is defined as pain that persists for three months or longer.

    “Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.” – Alex Azar, U.S. Secretary of Health and Human Services1

    Medicare Advantage plans may also now cover acupuncture to treat lower back pain, as Medicare Advantage plans offer at least the same benefits as Original Medicare . Most Medicare Advantage plans also offer prescription drug coverage.

    Acupuncture Coverage With Medicare Advantage Plans

    Medicare Advantage plans offer additional coverage for services not covered by Original Medicare. Whats exactly covered depends on the Medicare Advantage plan you choose. These are offered by private insurers whose terms vary. Most Medicare Part C plans offer dental and vision care, for example, and some offer additional perks like gym memberships. Some plans may therefore include expanded acupuncture coverage.

    Remember, Medicare Advantage plans may only support work done by practitioners within a provider network. So once you know you can get acupuncture, review your Part C plans guidelines about whose services are covered. As a reminder, Medicare Advantage Plans are of four general types:

    • Health maintenance organization plans
    • Special needs plans

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    Does Medicare Cover Acupuncture

    Acupuncture for back pain can actually be covered by Medicare

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    Acupuncture and Medicare two words that I never thought would be together in the same sentence. However, now that they are connected, its time to learn about acupuncture and Medicare, especially if you suffer from chronic low back pain.

    The practice of acupuncture most likely originated in China over 2,500 years ago. Traditional Chinese medicine believes inserting thin needles through the skin to stimulate specific points on the body rebalances the flow of energy.

    In the U.S., this alternative treatment struggled to gain acceptance. Research findings were inconclusive, and it was viewed as creating a placebo effect more than medical relief.

    That attitude started to change in 1997. The National Institutes of Health reported positive evidence for acupunctures effectiveness. Research studies demonstrated acupunctures value in treating nausea , dental pain, headache, and back pain.

    Even though more than 10 million acupuncture treatments are administered annually in the United States alone, insurance coverage has been described as inconsistent. One survey of 45 commercial, Medicaid, and Medicare Advantage plans found that only one-third covered acupuncture, suggesting most patients pay for acupuncture treatments entirely out-of-pocket.

    The Opioid Crisis

    Heres What You Need to Know

    If you have Part A and Part B, along with a Medicare supplement insurance plan :

    If you elected Medicare Advantage:

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