Does Medicare Cover Acupuncture?

Does Medicare cover acupuncture? What about treatments from naturopathic physicians? We’re hearing these questions from more and more Medicare beneficiaries, all of whom are curious about whether acupuncture and holistic health approaches are included in their coverage. 

So, what's included in Medicare's coverage? Discover the answers in this article.

What Is Acupuncture?

Acupuncture is identified by the Mayo Clinic as a fundamental element of traditional Chinese medicine. It involves the insertion of needles at specific points across the body. The primary objective of acupuncture is to facilitate natural healing, though it is most commonly employed for pain relief.

As we age, experiencing pain in various parts of the body becomes more common. In recent years, the Baby Boomer generation, in particular, has increasingly turned to acupuncture as a means of alleviating such discomforts.

Naturopathic physicians frequently utilize acupuncture to address a variety of ailments, including carpal tunnel syndrome, arthritis, back pain, fibromyalgia, and sciatica. However, before considering acupuncture as a treatment option, it's important to understand if and how it is covered by Medicare.

Does Medicare Cover Acupuncture?

Medicare's coverage of acupuncture pivots on the principle that if a treatment is medically necessary, it will be covered. Until 2020, neither acupuncture nor any other form of naturopathic medicine was deemed medically necessary by Original Medicare (Parts A and B). This stance changed on January 21, 2020, when the Centers for Medicare and Medicaid Services (CMS) decided to include acupuncture in Medicare coverage, specifically for treating chronic lower back pain. This move was part of a broader strategy to offer alternatives to opioids for pain management.

Medicare defines chronic lower back pain as pain that lasts for at least 12 weeks and arises from an indeterminate condition or disease. Under Medicare's guidelines, beneficiaries eligible for acupuncture can receive up to 12 sessions over three months. If there's a noticeable improvement, Medicare may cover eight additional sessions, capping the total at 20 sessions per year. Future coverage in subsequent years is also possible.

If your acupuncture treatment is covered by Medicare and you have a Medicare Supplement plan, your out-of-pocket costs could be significantly reduced or even eliminated. For instance, with a Medigap Plan G, Medicare will cover the sessions once you’ve paid the Part B deductible.

Some Medicare Advantage plans also cover acupuncture. These plans, which are an alternative to Original Medicare, combine Parts A and B with additional benefits such as dental, vision, and hearing. Like Original Medicare, Medicare Advantage plans are required to cover acupuncture for chronic lower back pain, and they may extend coverage to other conditions.

However, it's crucial to remember that each Medicare Advantage plan varies. Benefits are plan-specific, so it's necessary to check your plan's details. In regions where holistic medicine is more prevalent, like California, you might find Medicare Advantage plans offering broader integrative benefits, including acupuncture.

Does Medicare Cover Chiropractic Care?

Medicare does provide coverage for certain types of chiropractic care under specific conditions. Under Medicare Part B, chiropractic services are covered when deemed medically necessary, particularly focusing on the treatment of spinal subluxation. Spinal subluxation refers to a condition where one or more bones in the spine are misaligned, which can lead to discomfort, headaches, stiffness, and reduced flexibility.

If you visit a chiropractor for spinal subluxation, Medicare may cover the cost of the spinal adjustments. However, it's important to note that Medicare's coverage is limited to the treatment of subluxation. This means that other services often offered by chiropractors, such as x-rays, massage therapy, or other forms of therapy provided in a chiropractic clinic, are not covered.

For the chiropractic services that are covered, Medicare typically pays 80% of the approved amount, and the beneficiary is responsible for the remaining 20%. Additionally, the coverage may be subject to certain limitations, such as the number of visits. Again, if you have a Medigap plan, your cost-sharing amount may be less.

Beneficiaries enrolled in Medicare Advantage plans should review their specific plan details to understand how chiropractic care is covered. Medicare Advantage plans must offer at least the same level of coverage as Original Medicare but may provide additional benefits or have different rules regarding the coverage of chiropractic care. 

What Is Naturopathic Medicine?

Naturopathic medicine is a form of healthcare that emphasizes natural and holistic approaches to the treatment and prevention of health conditions. It's often seen as more than just medical practice but as a life philosophy. Practitioners of naturopathy, known as naturopathic physicians, hold a core belief that the body possesses an intrinsic ability to heal itself, often prioritizing this instead of relying on prescription medications.

The roots of naturopathy can be traced back to Dr. Benedict Lust, regarded by many as its founder. He introduced techniques from Germany to the United States in 1892 and in 1902, established the American School of Naturopathy.

In their practice, naturopathic physicians adhere to six foundational principles:

• The healing power of nature

• Identify and treat root causes

• First, do no harm

• Doctor as teacher

• Treat the whole person

• Prevention

Patients consult naturopathic practitioners for a variety of reasons, including pain management, hormone balancing, and improving sleep quality. Naturopathic medicine encompasses a range of techniques, each reflecting these six guiding principles. Among these, acupuncture stands out as a particularly sought-after therapy. Having a history of over 2,500 years, acupuncture is highly valued by naturopathic physicians.

Does Medicare Cover Medical Marijuana?

Despite the legalization of medicinal marijuana in over 30 states, Medicare does not cover its use. This is primarily because the Food and Drug Administration (FDA) has not approved marijuana for medical purposes, and the federal government classifies it as a Schedule I controlled substance. This classification indicates that marijuana is considered to have no accepted medical use and a high potential for abuse, which is a key reason why Medicare does not provide coverage for it.

However, there is an exception when it comes to certain FDA-approved cannabinoids. Dronabinol, a cannabinoid medication, is prescribed for specific medical conditions. It is used to address weight loss or appetite loss in illnesses and to treat nausea and vomiting associated with certain cancer treatments. As dronabinol is FDA-approved, it may be covered under some Medicare Advantage (Part C) or Medicare Part D prescription drug plans.

If you are considering dronabinol as a treatment option, it's advisable to consult your plan’s drug formulary. This will help you determine whether these medications are included in your plan's coverage. Each Medicare Advantage or Part D plan has its own formulary, so coverage for medications like dronabinol can vary from plan to plan.

Does Medicare cover CBD oil?

Medicare does not currently cover Cannabidiol (CBD) oil. Despite its growing popularity as a pain relief option and its legalization in many states, CBD oil falls into a similar category as medical marijuana in the context of Medicare coverage. Since CBD oil is not approved by the Food and Drug Administration (FDA) for medical use and lacks comprehensive clinical trials to substantiate its medical benefits, Medicare does not include it in its coverage.