Does Medicare Cover Acupuncture in 2020?

September 17, 2019

• Medicare Advantage

East Asian countries have practiced acupuncture for centuries, but it has only been popular in the United States since the 1970s. 

Today, more than 10 million acupuncture treatments are administered each year in the U.S – but is acupuncture covered by insurance? The practice is still often considered “alternative,” with some doctors wondering if acupuncture may be no more than a placebo effect. For that reason, there are lots of insurance policies that do not cover acupuncture.

Acupuncture is becoming increasingly popular among seniors because treatments can help reduce the effects of aging (such as stress, back pain, neck tension, and joint pain). However, your out-of-pocket costs can add up quickly, so you may be wondering…does Medicare cover acupuncture?

When does Medicare cover acupuncture?

You might be surprised to learn that starting in 2020, Medicare does cover acupuncture for qualified beneficiaries who experience chronic lower back pain. By definition, chronic lower back pain is pain that is not associated with surgery or disease and lasts for at least 12 weeks. If your doctor doesn’t recommend acupuncture or diagnose you with chronic pain, you might not qualify. Talk to your doctor to find out if acupuncture may be an option for you. 

Does Medicare Part B pay for acupuncture?

Before 2020, acupuncture was not covered by Medicare because it was not considered medically necessary (and was considered a form of holistic or alternative medicine, which is traditionally not covered). It was added to Medicare Part B in 2020 as a part of the wider effort to reduce the opioid crisis in America. CMS (Centers for Medicare and Medicaid Services) decided that it was necessary to provide pain management alternatives, and acupuncture made the list.

Medicare Part B will cover up to 12 treatments within 90 days for chronic lower back pain. If the treatments are effective, you can receive an additional eight covered sessions. There is a limit of 20 treatments per year. Your treatments must come from a doctor with a degree in acupuncture or Oriental Medicine from an accredited school. The doctor must be licensed and unrestricted in your state.

Do Medicare Supplements Cover Acupuncture?

Medicare supplemental insurance for acupuncture may be a good idea, depending on your other health conditions. Medicare supplement plans do not provide additional health benefits (like acupuncture), but they provide additional financial support for all your healthcare needs.

For example, Medicare Supplement Plan G will cover your Part B coinsurance and copayments. Since Part B covers acupuncture, if you have Plan G, you won’t have to pay any coinsurance or copayments for your acupuncture services. That means that while Medicare Supplements usually don’t directly cover acupuncture, they can help you pay for your treatments.

Do Medicare Advantage Plans Cover Acupuncture?

Since Original Medicare did not cover acupuncture before 2020, private insurers sometimes included acupuncture and chiropractic treatments in their Medicare Advantage plans. Even though Part B now covers acupuncture treatments, you might still find a Medicare Advantage plan helpful.

There is currently a yearly maximum of 20 treatments for Medicare Part B acupuncture coverage. Some Medicare Advantage plans might offer coverage for additional treatments. Additionally, Medicare Advantage plans that include prescription drug coverage can help you out with pain medications and whatever other prescriptions you need to make up for the lack of acupuncture coverage.

Aside from acupuncture and pain relief benefits, Medicare Advantage plans often include additional benefits like dental, hearing, vision, and even physical fitness.

How can a Medicare MSA Plan Help?

A Medicare Medical Savings Account, or MSA, is similar to a Health Savings Account but is a type of Medicare Advantage plan.

MSAs are different from other types of Medicare Advantage plans in that they typically do not cover prescription drugs. However, some Medicare MSA plans cover acupuncture.

This is an excellent option if you are healthy, not taking expensive prescriptions, and are more worried about cost savings than receiving additional health benefits.

When did Medicare start covering acupuncture?

Medicare began covering acupuncture in January of 2020. The Centers for Medicare & Medicaid Services (CMS) released a memo on January 21, 2020, announcing this change. Alex Azar, the Department of Health and Human Services Secretary, said, “Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis.”

The whole point of providing acupuncture coverage is to offer a range of treatment options so that Americans (seniors in particular) who are experiencing severe pain don’t always have to resort to opioids.

Read the CMS memo on acupuncture here.

Does Medicare Cover Other Naturopathic Treatments?

Naturopathy, or naturopathic medicine, is based on folk medicine and vitalism instead of traditional western medicine. It uses natural healing methods and promotes self-healing. Some might also call this “holistic” medicine.

Medicare typically does not cover any form of alternative medicine like naturopathy. One great example is chiropractic care. Medicare will only cover chiropractic services for medically necessary spinal manipulation when provided by a qualified chiropractor. Chiropractic services for massage therapy or pain treatment will not be covered.

How Much Does Acupuncture Cost?

According to Acufinder, an acupuncture referral service, you can expect to pay anywhere from $60 to $120 per service. Your rate can depend on where you are located. If you use a licensed acupuncturist and receive Medicare Part B coverage, you can expect to pay 20% of the fee, so you might only owe $12 to $24 per service. If you surpass the Medicare Part B limit of 20 treatments per year, or if you have not yet met your Part B deductible, you will have to pay full price. Once you meet the deductible ($144.60 in 2020), you can get your 80% coverage of acupuncture services.

Benefits of Acupuncture

Acupuncture is a unique and safe alternative to opioids for pain management. It works by inserting fine, sterile needles into the skin to stimulate very specific points (called acupoints). 

The practice of acupuncture began in China thousands of years ago. The ancient Chinese believed that human bodies were filled with a force called “qi,” pronounced “chee,” and that when your “qi” was blocked, you would feel ill. Acupuncture was created to help humans achieve qi balance. 

Studies have proven that even if there is no evidence of qi, we do know that acupuncture reduces chronic pain. Some doctors believe that acupuncture can also reduce the effects of allergies, anxiety and depression, insomnia, migraines, and more.

According to the University of California San Diego, acupuncture is an “effective treatment” for a variety of health issues such as:

• Allergy symptoms such as hay fever
• Arthritis
• Chronic low back pain
• Depression
• Headache
• Hypertension (high blood pressure)
• Hypotension (low blood pressure)
• Knee pain
• Nausea and vomiting
• Neck pain
• Postoperative pain
• Renal colic
• Rheumatoid arthritis
• Sciatica
• Stroke
• Tennis elbow

How to find a licensed acupuncturist

Acufinder.com is a great source for finding licensed acupuncturists.

Another way to find an acupuncturist is to simply run a Google search for “acupuncture near me.” However, make sure that you find a real, licensed acupuncturist. You can also try searching for “holistic doctors that accept Medicare near me.” Keep in mind that Medicare will cover not all holistic services, but a holistic doctor may be a qualified acupuncturist. 

Even if you think an acupuncturist who doesn’t have the proper credentials is trustworthy, Medicare beneficiaries should always try to find certified doctors. Medicare.gov’s Physician Compare tool is a great source for finding doctors that accept Medicare. You can also try visiting your private health plan’s website or asking your insurance agent for help. 

Get Acupuncture Coverage

If you want acupuncture coverage and general cost savings, a Medicare Advantage plan may be the way to go. More than 20.4 million beneficiaries are taking advantage of the benefits that MA plans offer.

Ready to learn more? Our agents can offer most major plans in your state! This means that you can enroll in the MA plan that best fits your needs and budget. Call us at 844-431-1832 or fill out this form to arrange a no-cost, no-obligation appointment with an agent in your area.