Does Medicare Cover Acupuncture?
Does Medicare Cover Acupuncture?
By Danielle Kunkle
Today’s market for alternative and integrative healthcare services is massive. NBC News reported in 2016 that Americans spent $30 billion in 2012 alone on treatments ranging from acupuncture to homeopathy. Many studies suggest that alternative approaches to healthcare can help with pain, healing, flexibility, inflammation and other types of recovery related to health conditions.
One very popular form of complementary healthcare is acupuncture. A traditional Chinese medical practice, acupuncture stimulates various points on your body to reduce pain by inserting very thin needles into your skin. Studies suggest that acupuncture may help with relieving headaches or migraines, reducing neck and back pain, aiding in digestion, regulating mood and also calming anxiety.
Original Medicare and Acupuncture
While healthcare in the U.S. seems to be moving full steam ahead with alternative healthcare, Medicare is not quite there yet. Original Medicare is made up of Part A, which is hospital coverage and Part B, which is outpatient coverage. At this time, neither part covers acupuncture, or most other forms of alternative healthcare, for that matter.
If you feel like acupuncture is a type of treatment that will help you, be aware that Original Medicare will not cover this treatment. You should plan to pay for that care out-of-pocket. Consider asking the practitioner whether he or she can offer cash discounts or if there is a package of appointments that you can buy in bulk for a discount.
Also, if you have a health savings account from before you joined Medicare with funds still in it, you can use those funds to pay for acupuncture. Acupuncture is a qualified medical expense per IRS rules.
Sometimes people will ask us if their Medigap plan will pay for the acupuncture when Original Medicare does not. Unfortunately, Medigap plans generally only pay supplemental benefits after Medicare has first accepted a claim and paid its share. If Medicare denies the claim, your Medigap plan legally cannot pay any benefits toward that service.
Though Original Medicare does not cover acupuncture, it’s possible that some Medicare Advantage plans may cover acupuncture, so that may be an alternative to explore.
What are Medicare Advantage Plans?
Medicare Part C is also referred to as Medicare Advantage. Advantage plans are private Medicare plans that pay instead of Medicare itself. These plans are developed and marketed by insurance companies. Each Medicare Advantage plan must cover all the same Part A and B services that Original Medicare does. However, you will seek those services under the plan’s rules.
Medicare Advantage plans often have significantly lower premiums than Medigap plans because you will use the plan’s network for most medical services. There are 
several different types of Medicare Advantage plans, including Medicare HMO, Medicare PPO and Medicare PFFS plans. There are also Special Needs Plans for individuals with qualifying conditions. The two most common network types are HMO and PPO.
In an HMO plan, you will choose a primary care doctor and see him first for a referral before consulting a specialist. You must use the network except in emergencies. PPO plans are a bit more flexible. You can see doctors outside the network, although you pay higher costs to do so.
Medicare Advantage companies are allowed to include extra benefits in their plans such as routine vision, dental and hearing care, gym memberships and transportation benefits. Acupuncture is also another benefit that Medicare Advantage plans may include in their coverage. If you consult a practitioner for acupuncture, make sure he or she is in the plan’s network. You should verify ahead of time with him to confirm that his or her services are covered under your insurance plan.
Read More:
Typically, you will pay a copay for a doctor’s visit under a Medicare Advantage plan. Your plan may also require a copay from you to see an acupuncturist. There may also be limits to the number and scope of visits covered under the plan. Consult your plan’s Summary of Benefits for specifics on what your cost-sharing is for each type of medical service.
If you are interested in seeing which plans in your area might include acupuncturists, you can visit Medicare.gov for a list of plans in your area and then consult their benefits outlines, which can usually be found online.
###
Danielle Kunkle is a Medicare expert on the Forbes Finance Council and founder of Boomer Benefits, an award-winning insurance agency founded in 2005
