Medicare

Does Medicare Cover Massage Therapy?

While original Medicare does not recognize massage therapy as a medically necessary (fully insured) benefit, some privately-offered Medicare Part C plans offer coverage for massage therapy under special circumstances. Recipients may choose from various options to pursue “alternative” treatments, like Medicare massage therapy. Read on to see which options you have under Medicare.

Medicare Massage Therapy

Original Medicare (Parts A and B) provides government-subsidized healthcare to many individuals over 65 and others in qualifying circumstances. While these programs provide essential services to an important demographic, there are notable gaps in available treatments. One of these, massage therapy, has the potential to be an essential source of pain relief for those with joint pain and other ailments. However, it is generally not covered by original Medicare.

Medicare Part C, otherwise known as Medicare Advantage, is also subsidized by the government but administered directly by private insurers. Because Medicare advantage plans differ by provider, there is more potential for leniency of coverage. Therefore, there is a higher potential for a Medicare Advantage plan to cover massage therapy.

Still, for those concerned about the inability to get coverage for massage therapy, there are specific scenarios in which Original Medicare authorizes massage therapy, as well as a variety of other available options.

Does Medicare Pay For Massage Therapy?

Yes, Medicare does cover massage therapy, but only in specific circumstances and under specific plans. Americans who qualify for Medicare parts A and B may also qualify for part C, which sometimes covers extended benefits like Medicare massage therapy.

The federal government provides Medicare health insurance to seniors and some young people with qualifying disabilities. The government provides Medicare benefits to Americans who have contributed to the social security fund throughout their career once they reach retirement age. 

Medicare comprises four parts: 

  • Medicare Part A and Medicare Part B, also known as original Medicare, cover hospitalization and medical insurance, respectively. These plans cover in-patient and specific outpatient care.
  • Medicare Part C, or Medicare Advantage, provides health plans subsidized by the federal government but administered directly by private insurers. Because these plans change by the provider, more coverage options are available. However, those considering Medicare C need to remember that these plans are not free, and there will be some out-of-pocket charges and payments, such as monthly premiums.
  • Medicare Part D provides prescription drug coverage for recipients of original Medicare. Part D typically benefits recipients with at least two prescriptions in each commonly prescribed medication class. 

Due to the increased flexibility of Medicare Advantage, if you are trying to get massage therapy covered outright, you will want to pursue a plan that is a part of Part C.

What Is Massage Therapy?

Massage therapy is widely used to promote relaxation, alleviate soreness, and increase flexibility, but it also offers medical applications in a healthcare setting. Massage therapists can manipulate the body’s soft tissues to reduce chronic pain and help heal injuries. Clinicians may recommend massage therapy in conjunction with other medical treatments.

Practitioners, including osteopaths and occupational therapists, may refer patients experiencing bodily pain or stiffness to a massage therapist. Massage therapy can also provide non-invasive pain management solutions to seniors, especially those susceptible to conditions that tend to intensify with age, such as arthritis, osteoporosis, and high blood pressure.

What Parts of Medicare Cover Massage Therapy?

Whereas original Medicare covers only “medically necessary” healthcare, Medicare Part C may cover massage therapy as an “alternative” or “complementary” treatment. Candidates who qualify for Medicare parts A and B also qualify for Medicare Part C; however, not all recipients of original Medicare need the additional benefits of Part C coverage.

To enroll in Medicare Part C, candidates must already receive Medicare parts A and B and live in a Medicare-Part-C-eligible service area. They must also ensure their preferred Medicare Part C or Medicare Advantage plan accepts new enrollees during open enrollment.  

Medicare Advantage generally offers coverage through health maintenance organization (HMO) or preferred provider organization (PPO) plans. Established insurance providers such as Aetna, Blue Cross Blue Shield, and Cigna offer Medicare Part C plans; however, availability varies by coverage area. 

What About Medigap?

Medigap is offered through private insurance providers and generally covers the same services as original Medicare, which does not include massage therapy. Medigap offers supplemental coverage to Medicare Parts A and B recipients to offset out-of-pocket costs, including deductibles and copayments.

Candidates may enroll in either Medigap or Medicare Part C, but not both. Medigap benefits recipients who may need financial assistance to cover their share of expenses for a hospital stay or emergency medical procedure. Enrollees seeking massage therapy services should pursue Medicare Part C instead and confirm their plan offers this coverage.

Medicare Alternatives to Massage Therapy

While not every Medicare plan covers massage therapy, some may offer similar alternative or complementary treatments. Physical therapy, chiropractic therapy, and acupuncture are among the most common therapeutic and preventive services covered by a Medicare plan.

Medicare is particular and, in some cases, limited in its coverage of these treatments. Only certain services and in-network providers may be covered, sometimes only if the treatment is deemed medically necessary. Medicare typically only covers a set number of visits to specialized practitioners within a given period. However, Medicare offers other options if the treatment is considered medically necessary.

Physical Therapy

Physical therapy can help patients resolve issues, including illness, injury, or disability, affecting their routine body function and movement. Medicare Part B covers 80% of the costs of outpatient physical therapy, provided a doctor certifies that it is medically necessary, once the patient meets their Part B deductible that year. 

Chiropractic Therapy

Chiropractic therapy involves the manual adjustment of the skeletal spine to relieve pressure and sciatic pain, especially in the upper and lower back, neck, and shoulders. Medicare Part B covers 80% of chiropractic costs once the recipient has met their annual Part B deductible; however, coverage is strictly limited to minor manual manipulation and does not include tests, x-rays, or referrals for supplemental treatments. 

Acupuncture

Acupuncturists insert thin needles into strategic points on the body, enabling a re-balancing of one’s “chi” or flow of energy. Medicare Part B covers up to 12 acupuncture sessions in a 90-day period only if used to treat chronic lower back pain. Patients who show improvement may continue treatment for a maximum of 20 visits in 12 months. Patients pay 20% after meeting their Medicare Part B deductible.  

Understanding Massage Therapy Benefits

Medicare recipients should explore the details of massage therapy benefits through their individual Medicare Advantage plan. Since Medicare Part C plans are issued by private companies and coverage varies by provider, recipients must confirm the maximum number of visits allowed and meet the deductible threshold under their particular plan. 

Medicare recipients should not confuse massage therapy with physical or occupational therapy benefits, which are covered as potentially medically necessary under Medicare Part B.

Tips for Affordable Massage Therapy

Applicants seeking insurance for preventive and therapeutic treatments should research available Medicare Advantage plans covering massage therapy in their area. Enrollees in a Medicare Advantage plan with massage therapy benefits should always seek a formal referral or prescription from their doctor to qualify for coverage for this treatment.

Uninsured individuals seeking affordable massage therapy can pursue other avenues, including massage schools, discounts, promotional coupons, and research study opportunities. Massage schools regularly offer discounted rates for clients willing to be treated by massage therapists-in-training. Additionally, massage facilities often attract new clients with promotional specials and/or compensation for clinical studies.