February 14th 2024
By Ari Parker
While acupuncture can be used to treat a variety of conditions, Medicare only covers the therapy for people with chronic lower back pain.
Acupuncture is an alternative medicine that people have practiced for thousands of years. The practice uses thin needles to treat pain and other health conditions by stimulating specific points on your body. Acupuncture can be used for managing pain, joint issues, stress, and neuropathy.
Medicare only covers this type of therapy for people who have chronic lower back pain. In this post, we'll explain what to expect around Medicare coverage for acupuncture and the limitations you may experience.
Medicare pays for acupuncture only to manage chronic lower back pain.
Medicare covers up to 20 sessions in one year if you show signs of improvement after treatment.
A Medicare Advantage (Part C) plan may have broader coverage for acupuncture, but policies could also be more restrictive.
Dating back to ancient China, acupuncture can help soothe many different ailments like chronic pain, headaches, osteoarthritis, and nausea associated with chemotherapy. You can often use acupuncture to complement your existing treatment. For example, people with osteoarthritis can use acupuncture and prescription drugs covered by Part D as part of a more holistic plan.
According to traditional Chinese medicine, acupuncture works by restoring the balance of energy, or "qi" (pronounced chi), in your body. Acupuncturists insert thin needles into specific points or "meridians" along your body, which are pathways of points that qi flows through. The needles are meant to guide the flow of energy and promote the body's natural healing processes.
In more modern views of acupuncture, experts believe that the therapy stimulates nerves, muscles, and connective tissue to release endorphins, which results in pain relief. Some studies also suggest that acupuncture has therapeutic benefits by affecting the neurotransmitters and hormones in your body.
Adults who have chronic pain, arthritis and other joint issues, muscle tension, stress, and chronic headaches can experience the following benefits from acupuncture.
Pain relief: Acupuncture can help you manage chronic pain conditions and musculoskeletal pain by releasing natural endorphins.
Reduced inflammation: The alternative medicine can manage arthritis and other inflammation-related conditions through anti-inflammatory effects.
Relaxation: Acupuncture releases endorphins, which can help you relax.
Muscle relaxation: Acupuncture may help relax muscles and improve joint mobility.
Headache and migraine relief: Acupuncture may help reduce the frequency and intensity of headaches.
Acupuncture is widely used to help treat many conditions, such as:
Addiction
Asthma
Carpal tunnel syndrome
Dental pain after surgery
Fibromyalgia
Headaches
Low back pain
Menstrual cramps
Myofascial pain
Osteoarthritis
Stroke rehabilitation
Tennis elbow
Upset stomach (nausea) caused by surgical anesthesia and cancer chemotherapy.
Despite the popularity and effectiveness of acupuncture treatments, the process is largely considered an alternative therapy. There are many ways acupuncture can help provide relief, but Medicare will cover acupuncture for only one condition: chronic lower back pain. Medicare coverage also only became an option for acupuncture in 2020, when the Centers for Medicare & Medicaid Services (CMS) finalized approval for limited use.
The policy change was a response to the opioid crisis, which left many people in pain and addicted to oxycodone and other habit-forming drugs. By promoting a pain-management approach, CMS hoped to lessen reliance on prescription drugs to relieve pain and discomfort.
While many people have widespread chronic pain, coverage was limited to chronic lower back pain. This is because a body of research supported the fact that acupuncture treatments reduced pain in many study participants over 65. Medicare coverage for other conditions depends on future research results.
There are several criteria you have to meet before Medicare will pay for acupuncture:
Your lower back pain lasts for 12 weeks or longer
Your pain isn't associated with an identifiable disease like cancer or inflammatory disease
Your pain isn't from surgery or pregnancy.
If you meet these qualifications for chronic low back pain, Medicare Part B covers up to 12 acupuncture sessions in 90 days. Once you've met your Part B deductible, Medicare will pay for 80% of the cost of treatment, leaving you responsible for the remaining 20% coinsurance. A Medicare Supplement (Medigap) plan can help reduce your out-of-pocket costs after Original Medicare has paid. (Learn more about the benefits of Medicare Supplement plans.)
Medicare starts by covering 8 visits to see if acupuncture treatment will work for you. If you show improvement after these 8 sessions, Medicare will cover an additional 8 sessions. Medicare will cover a maximum of 20 acupuncture treatments within a 12-month period. If you need to see an acupuncturist more than that, you'll have to pay for their services on your own.
Some Medicare Advantage plans have broader coverage for acupuncture, including treatment for other conditions. However, out-of-pocket expenses can vary between plans, and you could have more limitations, like provider networks. Always check with your acupuncturist and/or insurance company ahead of time to see what you'll have to pay for acupuncture visits.
For Medicare to cover acupuncture, your acupuncturist must:
Be licensed in the state where they practice
Be certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)
Acupuncturists are highly trained. In the US. Most have a master's degree in acupuncture or a Chinese medicine program. Most also went through an internship. The field is moving toward requiring doctoral degree training.
Some states also allow certain medical doctors, chiropractors, and other licensed healthcare professionals like nurse practitioners to perform acupuncture if they have completed the necessary training and certification.
Most states enact Acupuncture Practice Acts that state their licensure requirements, but their content varies. It's important to choose a qualified acupuncturist who has completed the necessary training and is licensed in your state. You can find a licensed acupuncturist in your area by searching online or contacting your local healthcare provider.
There are a few limitations of Medicare coverage for acupuncture, which can make getting treatment challenging. We outline the requirements for acupuncture coverage below.:
The acupuncturist or provider you see must be properly accredited and licensed. The treatment has to be administered by someone with a higher level degree in acupuncture or Oriental medicine from a school that has the proper credentials. They also must have full license to practice acupuncture in the area where you receive care.
Medicare's coverage only extends to treat lower back pain. Medicare does not cover acupuncture for neuropathy or neck pain.
Medicare will not continue to pay for acupuncture if you aren't showing signs of improvement after 8 sessions.
While Medicare's coverage of acupuncture is limited, there are other treatment options that it does cover. You can explore other alternatives like, physical therapy, medication, or a medical device for better mobility. Interestingly, some physical therapists offer a procedure similar to acupuncture called dry needling. While Medicare benefits do not include dry needling as a stand-alone treatment, it may be covered as part of a comprehensive physical therapy treatment plan.
Though Medicare coverage for acupuncture is still very limited, a movement is underway to make acupuncture part of an integrative health plan for seniors. For example, Representatives Judy Chu (CA-28) and Brian Fitzpatrick (PA-01) introduced the Acupuncture for Our Seniors Act of 2023 to increase access to acupuncture in our healthcare system.
Our licensed Medicare Advisors can help you understand your Medicare coverage and all of its benefits. Get personalized, free Medicare advice! Call us at 855-900-2427 or schedule a time to talk at your convenience.
