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does medicare cover acupuncture

Does Medicare cover acupuncture in Florida?

If you’re struggling to understand Medicare in Florida, Connie can help. Ask Connie your question, and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.

Dear Connie,

I believe acupuncture is important for my overall wellness and helps with my lower back pain. I’ve been seeing an acupuncturist for several years regularly. Luckily, my health insurance has always covered these visits.

I become eligible for Medicare in two months, and I’m wondering, does Medicare cover acupuncture in Florida? Which plan should I sign up for if I want to continue going?

I love acupuncture,
Donna from Palm Harbor, Florida

Find the right Medicare plan for you

Dear Donna,

We love your enthusiasm, and we’re glad you’ve found a wellness routine that works for you.

Like you, many people visit an acupuncturist to improve the energy flow throughout their body. Many believe this energy flow is responsible for overall health. Those who see an acupuncturist often feel relaxed or energized after a session.

Yes, Medicare does cover acupuncture for chronic pain – on a limited basis.

In January 2020, Original Medicare Part B began covering limited acupuncture visits in response to the opioid crisis. At the time, many Medicare beneficiaries were being prescribed opioid medication, and acupuncture is an alternative pain management.

Agent tip:

“If you’d like to visit an acupuncturist more than 20 times in a year or for reasons other than chronic lower back pain you may consider a Medicare Advantage plan with more expansive coverage.“

Medicare will cover up to 12 acupuncture visits within 90 days – if the visits are related to chronic low back pain and completed by a Medicare-approved provider.

The Centers for Medicare & Medicaid Services defines chronic lower back pain as lasting 12 weeks or longer.

Your chronic lower back pain cannot be caused by metastatic, inflammatory, infectious, or other diseases. And the pain cannot be associated with surgery or pregnancy.

You must receive your acupuncture care from a Medicare-approved doctor or other health care provider, like a nurse practitioner or physician assistant. A Medicare-approved provider must have the following:

Medicare will approve eight additional acupuncture sessions with a Medicare-approved provider if you experience pain relief and improvement. If there aren’t signs of improvement, the treatments will be discontinued.

You can receive 20 acupuncture treatments within 12 months, but there are some out-of-pocket costs. After you meet the Medicare Part B deductible ($226 in 2023), you’ll pay 20% of Medicare-approved expenses. Original Medicare Part B will cover the other 80% of the costs.

According to national studies, an acupuncture session can cost between $70 – $150, depending on where you live and the expertise of your practitioner. Should the average session cost $110, Medicare Part B would pay $88 (80% of costs), and you would need to pay $22 out-of-pocket. That is unless you have a Medicare Supplement (Medigap) or Medicare Advantage plan.

Because Original Medicare doesn’t have a maximum for out-of-pocket expenses, many people opt for enrolling in a Medicare Supplement or Medicare Advantage plan. A Medicare Supplement plan can help pay for some or all of your out-of-pocket costs. If you plan on those 20 acupuncture visits over the year, a Medicare Supplement plan could save you an average of $440 on out-of-pocket costs for these visits alone.

A Medicare Advantage plan must offer the same benefits as Original Medicare, so they’ll also provide the 20 acupuncture treatments, if eligible, along with extra benefits and potential cost savings. With a Medicare Advantage plan, you could get dental, vision, and hearing benefits. Plus, some Medicare Advantage plans offer acupuncture for reasons other than chronic lower back pain, such as nausea or general chronic pain.

Although you’ve been going to an acupuncturist for lower back pain, Original Medicare has limited coverage. So, you may find access is restricted. Suppose you’d like to be able to visit an acupuncturist on a more frequent basis or for reasons other than chronic lower back pain. In that case, you may consider a Medicare Advantage plan with more expansive coverage.

I hope this information helps you understand if the acupuncture care you seek is covered by Medicare in Florida. If the reason you are visiting an acupuncturist relates to chronic lower back pain, you could extend your visits for a limited time. However, if it’s for another reason, you may want to explore Medicare Advantage plans. They may better suit your health needs.

At Connie Health, we help you throughout your Medicare journey. We’d be happy to help you find a plan that offers the acupuncture coverage you want and that’s right for your health and budget. If you have additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711).

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Read more by William Revuelta

I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.

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