December 20th 2023
By Ari Parker
This article explores the coverage options for massage therapy under Medicare. Learn more about Medicare coverage for massage therapy and what other therapy alternatives are covered.
While getting a massage is often considered a nice way to treat yourself and relax, you could be considering massage therapy for a number of reasons. Many people receive massage therapy services to help with chronic pain management and anxiety management.
Original Medicare does not cover massage therapy unless it’s part of a holistic physical therapy treatment plan, but this is rare. Some Medicare Advantage plans cover massage therapy if it is considered medically necessary.
Because massage therapy is considered an alternative medicine, Original Medicare does not cover the service. It may be covered as part of a physical therapy treatment plan, but this is uncommon.
Some Medicare Advantage plans cover massage therapy, but only if it is medically necessary to treat a specific health condition.
While massage therapy is often thought of as a relaxing activity, it has health benefits and can help with a number of health conditions. Doctors may recommend massage therapy to help with recovery after surgery and chronic conditions like anxiety and depression, fibromyalgia, osteoporosis, and arthritis. Though many people find massage therapy helps alleviate health problems, Original Medicare considers it an alternative medicine. Alternative medicines are not considered medically necessary, so Medicare does not typically cover them.
Original Medicare does not cover any part of massage therapy. You’ll have to pay 100% of the cost for the service even if you’re using it to treat a chronic medical condition. Original Medicare may cover massage therapy if it’s included as part of a physical therapy treatment plan. However, this scenario is not common.
In some circumstances, Medicare Advantage plans can cover alternative medicine if it is medically necessary to treat a person’s health condition. This means that Medicare Advantage won’t cover massage therapy if it’s for general relaxation.
In order to get coverage from Medicare Advantage, you must meet the following requirements:
Find a state-licensed massage therapist
Get a prescription from a doctor or medical professional to treat a medical issue with massage therapy
Not all Medicare Advantage plans cover massage therapy, so be sure to check that yours does before receiving the service. You may also be required to get prior authorization for massage services in order to receive coverage. Once you’ve confirmed coverage and gotten any necessary prior authorizations, you’ll likely owe some portion of the cost of the service through copays, coinsurance, and deductibles. These out-of-pocket costs vary between plans, so check with your insurance company beforehand so you know what charges to expect.
While you can’t get coverage for massage therapy, Medicare does cover other treatments for chronic pain.
Medicare helps pay for the following therapy services:
Physical therapy: If it’s medically necessary, Medicare covers physical therapy. There’s no limit on how many sessions are covered each year.
Acupuncture: Medicare covers acupuncture only if it is necessary to treat chronic back pain. To be eligible for coverage, the back pain can’t be from surgery or pregnancy, it can’t have a known cause, and the pain must continue for at least 12 weeks. If you meet these conditions, you’ll have 20 maximum visits covered each year.
Chiropractic care: Like acupuncture, Medicare covers the services of a chiropractor if you have chronic back pain. It will only pay for chiropractic care if you need it to correct an existing issue.
If these services are covered for you, you’ll still owe 20% of the cost after meeting your Part B deductible. This 20% is your Original Medicare coinsurance. A Medicare Supplement plan can help reduce your out-of-pocket costs. With Medicare Advantage, plan coverage and cost structures vary, so it’s best to check with your policy on how much you would have to pay.
To get coverage for any of these therapy alternatives, a doctor must prescribe them and deem them medically necessary to treat a medical condition.
If you need help understanding what your Medicare insurance covers for massage therapy or other health services, we’re here to help! Give us a call at (855) 900-2427 or schedule a free consultation to get your questions answered and help understanding and using your Medicare.
