Does Medicare cover acupuncture?
Acupuncture is an alternative medicine that people have been practicing for thousands of years. There are different forms of acupuncture, but more traditional techniques typically involve using needles to stimulate specific areas of the body. You can use acupuncture for managing pain, joint issues, stress, and neuropathy.
While acupuncture can be used to treat a variety of conditions, 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.
Key takeaways:
Medicare only covers acupuncture 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 plan may have broader coverage of acupuncture, but policies may also be more restrictive.
What is acupuncture?
Dating back to ancient China, acupuncture helps soothe many different ailments like chronic pain, headaches, osteoarthritis, and nausea associated with chemotherapy. You can often use acupuncture as a complement to your existing treatment. For example, people with osteoarthritis can use acupuncture and prescription drugs 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 needles into “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.
Benefits of acupuncture
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 conditions with inflammation issues 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.
Does Medicare cover acupuncture?
There are many ways acupuncture can help provide relief, but Medicare will cover acupuncture for only one condition: chronic lower back pain. There are also a few other 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 lower 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%. A Medicare Supplement plan can help reduce your out-of-pocket costs. (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. However, 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 insurance providers and you could have more limitations with in-network providers. Always check with your plan ahead of time to see what you’ll have to pay for acupuncture visits.
Limitations of Medicare coverage for acupuncture
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 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.
Our licensed Medicare Advisors and Advocates can help you understand your options for treatment and how Medicare coverage works. Get personalized, free advice at 855-900-2427 or schedule a time to talk at your convenience.