Yes, Original Medicare (Part A and Part B) covers acupuncture to treat chronic lower back pain. This coverage is fairly recent, as Medicare only began covering acupuncture treatments in 2020. Medicare Part B, which covers outpatient services, is the part of Original Medicare that provides coverage for acupuncture.
Table of Contents
The Benefits of Acupuncture
Acupuncture is an ancient East Asian healing practice dating back thousands of years. The practice involves inserting very fine needles into strategic pressure points on the body, which can help to relieve pain, reduce inflammation, and recalibrate the flow of energy or bodily “chi.”
While most traditional healthcare practitioners still consider acupuncture to be a form of alternative medicine, the practice is increasingly being incorporated into holistic treatment plans. Research indicates that acupuncture can be a beneficial addition to treatment for back pain and other ailments.
Understanding Medicare Coverage for Acupuncture
Original Medicare covers acupuncture treatments through Part B, provided beneficiaries can meet other specific eligibility requirements.
Eligibility
You must enroll in Original Medicare to receive Medicare-covered acupuncture treatments. Eligibility for Medicare benefits occurs automatically when you turn 65 or if you have a qualifying disability such as end-stage renal disease.
Medicare-covered acupuncture must meet the following two requirements:
- The practice must be to treat lower back pain.
- The acupuncture must be administered by a licensed acupuncturist.
Medicare Part A
Medicare Part A does not cover acupuncture. It covers hospitalization, nursing home care, and other inpatient services.
While Part A does not cover acupuncture treatments, most Medicare beneficiaries enroll in Part A and Part B simultaneously during their initial enrollment period (IEP) to avoid paying a late penalty and since Part A offers $0 premiums premiums for most enrollees. You would only use Part A coverage for inpatient services unrelated to acupuncture, such as being hospitalized for an illness or injury.
Medicare Part B
Medicare Part B is the part of Original Medicare that covers acupuncture. It’s only covered to treat chronic back pain, which Medicare defines as lasting for at least 12 weeks, not having an identifiable cause, and not caused by pregnancy or surgery.
Medicare covers 12 sessions over a 90-day period, plus 8 additional sessions if you show improvement. You pay 20% of the cost of care after meeting your Part B deductible.
Medigap
Medigap plans may help pay for your coinsurance for acupuncture after you’ve paid your deductible. Medigap, also known as Medicare Supplement Insurance, is designed to help pay some of the healthcare costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles.
Medigap encompasses 10 different plan options, with varied availability from state to state. Except for Plans C and F, you would still need to pay the Part B deductible to enjoy acupuncture coverage after purchasing Medigap.
How Does Medicare Advantage Cover Acupuncture?
Just like Medicare Part B, Medicare Advantage Plans will cover acupuncture for chronic lower back pain. By law, Medicare Advantage Plans are required to offer at least the same benefits as Parts A and B, which means it must cover 12 sessions over a 90-day period, plus 8 additional sessions if you show improvement.
Your plan may offer expanded acupuncture benefits for conditions beyond lower back pain or require you to obtain a referral or visit a doctor in its preferred network. Coverage details vary by plan, so check your specific plan or contact your provider for exact information.
How Much Does Acupuncture Cost With Medicare?
The American Institute of Alternative Medicine estimated a cost of $40-$85 for a patient’s first acupuncture session, with follow-up visits costing between $35 and $70. That cost can increase if your acupuncturist recommends additional treatments or techniques to maximize the therapeutic effects. These costs can add up for patients without Medicare or health insurance, but Medicare Part B and Medicare Advantage can help you save on out-of-pocket costs.
Medicare Part B Costs
Medicare Part B covers 80% of the cost of acupuncture treatments after you meet your deductible. The Part B deductible is $240 in 2024 and applies universally to all Medicare beneficiaries, regardless of their residence.
Once you pay your deductible, you will owe 20% of the cost of acupuncture treatments. However, the actual price may vary depending on the availability of practitioners in your area and the size of your network. For example, if an acupuncture session costs $70, Medicare would pay $56, and you would cover the remaining $14 after your deductible.
Medicare Advantage Costs
You will still need to pay your Part B deductible even if you have Medicare Advantage. Medicare Advantage premiums require an additional cost of $18.50 per month, on average, in 2024 but may also offer expanded access to acupuncture treatments and related therapies. You may qualify for $0 or low-cost Medicare Advantage Plans.
How to Find a Medicare-Approved Acupuncturist
Take these steps toward ensuring Medicare will cover your acupuncture treatments:
- Discuss acupuncture with your physician. If you are suffering from chronic lower back pain, your physician may recommend acupuncture as a viable treatment option. You may try acupuncture if you have exhausted other traditional treatments or explore with your doctor the idea of combining acupuncture with other therapies.
- Make sure you qualify. If your lower back pain has lasted for at least 12 weeks, with no identifiable cause and not due to surgery or pregnancy, your condition qualifies as “chronic.” Whether you receive benefits through Original Medicare or Medicare Advantage, you can get coverage for acupuncture.
- Find a provider. Visit Medicare.gov to find a provider in your area.Practitioners must hold an accredited graduate degree in acupuncture or oriental medicine and maintain a current state license to practice acupuncture for Medicare approval.
- Pay your Part B deductible. Make sure your Part B deductible is paid in order to start using your benefits toward acupuncture treatments. You may also owe a separate monthly premium to maintain benefits if you have a Medicare Advantage Plan.
Alternate Medicare-Covered Treatment for Pain Management
Medicare covers some other alternative treatments under certain conditions, including:
Physical Therapy
Physical therapy incorporates exercise or massage into treating chronic pain or physical injuries. Patients may seek physical therapy for various issues, including pain management, increased mobility, or recovery and rehabilitation. Medicare Part B only covers physical therapy when ordered by your healthcare provider. After meeting your Part B deductible, you would be responsible for 20% of the cost of physical therapy services.
Chiropractic care
Chiropractors make adjustments to your spine through manual manipulation. Medicare Part B covers chiropractic care only when used to correct a vertebral subluxation, which occurs when the vertebrae become misaligned and compresses the spinal nerves. After meeting your Part B deductible, you would pay 20% of the cost of treating a vertebral subluxation through chiropractic care.
All in All
Medicare covers acupuncture under Part B, provided the beneficiary and practitioner meet certain criteria. Patients must demonstrate a history of chronic lower back pain and may not use acupuncture as a treatment for any other condition, illness, or injury.
Additionally, Medicare-approved practitioners must hold a master’s degree or Ph.D. accredited by the Accreditation Commission on Acupuncture and Oriental Medicine and an active, unrestricted license to practice in your state.
If you’re suffering from chronic back pain and are interested in trying acupuncture, talk to your doctor about your options.
Frequently Asked Questions