Medicare does cover some acupuncture or chiropractic treatments. But, Acupuncture is only covered if it treats chronic lower back pain.
Further, Medicare only covers chiropractic manipulations to correct a misaligned spine.
Medicare won’t pay for other types of chiropractic and acupuncture treatments. But, some Advantage plans offer extra benefits beyond Medicare.
Below you’ll learn which services qualify for coverage and when you’ll pay the bill.
Medicare Coverage for Lower Back Pain Acupuncture
The decision is part of an effort to support alternative pain therapies and reduce dependence on opioid painkillers.
CMS says there were a small number of studies on acupuncture for lower back pain in people over 65. But the patients saw improvement in both pain and function.
The new Medicare rule applies to acupuncture for chronic lower back pain. There’s no Medicare coverage for acupuncture to treat neck pain, headaches, stress, or relief from chemo.
Does Medicare Cover Acupuncture for Other Pain
Medicare covers acupuncture for the pain that affects your lower back and is chronic.
“Chronic,” lower back pain must meet these criteria:
- The pain has lasted at least 12 weeks
- Pain doesn’t have an identifiable cause such as cancer or a disease
- Isn’t related to surgery or pregnancy
Medicare does NOT cover acupuncture to treat pain in other parts of the body. Also, Medicare doesn’t pay for acupuncture to treat temporary acute pain, such as pain from a recent injury.
But, Medicare will pay for up to 12 acupuncture visits in 90 days, and another eight for patients who have shown improvement. Medicare covers at most 20 sessions per year.
Medicare Coverage for Chiropractic Care
Manual manipulation of the spine by a chiropractor has Medicare coverage if it is medically necessary to correct a “subluxation.”
Subluxation is a medical term for the misalignment of the spine. But, Medicare doesn’t cover a visit to the chiropractor for other reasons.
If you see a chiropractor for spine manipulation, you should be aware that Medicare doesn’t include any services that doctor orders. For example, Medicare won’t cover x-rays a chiropractor’s orders. But, Medicare will cover chiropractic as long as you show improvement.
You pay the full cost of maintenance chiropractic care with Medicare.
Do Chiropractors Have to Accept Medicare
Chiropractors may be “participating” or “non-participating,” but they cannot opt-out.
A participating provider will bill Medicare and charge you only for the amount Medicare doesn’t pay.
A non-participating provider must bill Medicare, but may ask you to pay the bill and Medicare will reimburse you.
Medicare Chiropractic and Acupuncture Reimbursement
Acupuncture falls under Part B. Chiropractors accepting Medicare must accept the reimbursement rates as full payment.
In most states, chiropractors that don’t accept Medicare have the option of adding a fee. But, you can avoid “excess charges” by choosing a doctor that accepts Medicare. Also, you can avoid extra fees with a Medicare Supplement that covers excess charges.
For Chiropractic care, there is no cap on the number of visits Medicare will cover to correct a subluxation. Like Acupuncture, Chiropractic care falls under Part B.
Medicare Advantage Plans that Cover Acupuncture or Chiropractic Care
Advantage plans must offer the same benefits as Medicare. Some Advantage plans include extra benefits such as dental and acupuncture, for a range of conditions.
The private companies that sell Advantage plans decide which extra services to cove and options vary across the nation.
Routine Chiropractic care may have coverage on an Advantage plan. But, specific guidelines may apply.
For example, you may need to have a neuromusculoskeletal disorder, chronic nausea, or require pain relief.
Every Advantage plan is different, look at your explanation of benefits to see what your policy covers.
Tip: Not all Advantage plans offer Chiropractic or Acupuncture care.
Medicare Supplement Plans that Cover Acupuncture or Chiropractic Care
Medicare Supplement plans cover the same services and procedures as Medicare. Medigap doesn’t include extra services beyond Medicare.
But, a Medicare Supplement may pick up your part of the coinsurance for acupuncture for chronic lower back pain. When Medicare approves a service, Medigap pays.
The same goes for Chiropractic care; if Medicare covers a Chiropractic service, Medigap will pay its portion.
Tip: When your insurance doesn’t cover Chiropractic or Acupuncture services, ask local doctors about cash prices.
Medicare Chiropractic and Acupuncture FAQ’s
Does Medicare Cover Massage Therapy?
Your chiropractor may advise massage therapy to help ease the pain. Medicare doesn’t cover massage therapy.
Does Medicare Pay for Dry Needling?
Medicare doesn’t cover dry needling, even if its purpose is to relieve chronic lower back pain.
What is the Average Cost of Acupuncture Treatments?
According to Thervo, acupuncture costs between $50 and $90, depending on location. The average cost is $75, with a first visit costing more.
If you have acupuncture for chronic lower back pain, you pay the coinsurance rate per session. But, if you have acupuncture that’s not covered, you pay the full price.
Finding the Right Policy for Your Needs
Do you worry about the things Medicare doesn’t cover? Are you looking for a plan that includes alternative therapy treatments?
Those that want an “all-in-one” plan should consider looking into Advantage coverage. But, there are some downsides to Advantage plans.
Before you enroll, consider all the possibilities. Are you going to be comfortable with paying a copayment every time you see a doctor?
Does a network both you? How much is an emergency, and are you ready to pay those costs? Further, are you fully aware of all your options?
Our agents represent the top carriers in the nation, giving you a non-biased opinion on your options. Allow our agents to educate you on the available plans, and you can make the final choice about what’s right for you.
To find the right policy for you, give us a call at the number above. If you can’t call now, fill out an online rate form and see the options for yourself.