Does Medicaid Cover Acupuncture?
- Does Medicaid cover acupuncture? Find out whether Medicaid and Medicare covers acupuncture therapy, how many treatments you can receive and who's eligible.
Acupuncture is a treatment commonly used in traditional Chinese medicine. It involves inserting needles at strategic points on the body and is used to relieve pain, treat mental health problems and improve overall well-being.
Acupuncture is an alternative therapy, and various state and private health insurance policies are expanding their coverage to include traditional treatments like acupuncture. So, does Medicaid cover acupuncture? Below, you can find out about Medicaid and Medicare acupuncture funding and eligibility.
Does Medicaid Cover Acupuncture?
Medicaid may cover acupuncture for beneficiaries requiring treatment for chronic low back pain. Coverage for complementary therapies such as acupuncture varies according to state, and only Oregon and Minnesota include acupuncture in their Medicaid coverage as of 2021.
It's likely that more states will introduce Medicaid coverage for acupuncture in the future. Several states are considering expanding coverage for alternative pain relief measures to reduce the use of potentially addictive opioid painkillers.
Does Medicare Cover Acupuncture?
Medicare may cover acupuncture to treat chronic low back pain. It does not currently cover the treatment for any other purpose, such as treating mental health conditions.
Medicare may cover up to 12 acupuncture treatments within a 90-day period for eligible enrollees. You may be entitled to funding for an additional eight treatments if your doctor observes an improvement in your condition. If your doctor doesn't feel that the acupuncture treatment is effective, you will not be entitled to further sessions. Medicare caps the maximum number of funded acupuncture treatments to 20 per year.
Your treatment must be carried out by a doctor or another health care professional holding a valid acupuncture license for your state. The therapist must also hold a master's or doctorate in acupuncture or Oriental Medicine from an approved college.
If you're approved for funding, Medicare Part B pays for acupuncture treatment because it is carried out in an outpatient clinic. You are responsible for paying the $203 Part B deductible. Cost details are not available as of 2021 on the Medicare website, but you will likely need to pay 20% of the Medicare-approved amount for your acupuncture treatment.
Who Is Eligible for Acupuncture?
Medicare only considers funding acupuncture treatment for enrollees with low back pain that has persisted for 12 weeks or more. Your back pain must be idiopathic, which means that it has no clear medical cause. Medicare does not fund acupuncture for low back pain caused by surgery or pregnancy.
When Did Medicare Start Paying for Acupuncture?
Medicare finalized the decision to start paying for acupuncture for chronic low back pain on January 20, 2021.
How Much Does Acupuncture Cost?
You should expect to pay somewhere between $75 and $95 for your first acupuncture treatment if you don't have insurance coverage. Each subsequent treatment session is likely to cost between $50 and $70.
These costs should include an initial consultation when your therapist will examine you and gather any relevant medical history. Some clinics may offer a discount if you pay for multiple sessions in a block.
Out-of-pocket costs for acupuncture could be higher if your therapist recommends taking additional supplements to complement your treatment. Some clinics also expect gratuity payments, but this varies widely between practitioners.