Does Medicare Cover Massage Therapy?
- Find out the answer to the question does Medicare cover massage therapy, including information about what's covered by Medigap and Medicare Advantage policies.
Massage therapy isn't just an effective way to relax; it can also help treat various health conditions. However, ongoing massage therapy can be expensive, so many people want to know if their health care insurance will help them cover the costs. Does Medicare cover massage therapy? Find out the answer below as well as whether it will pay for any alternatives.
What Is Massage Therapy?
Massage therapy is performed by a licensed therapist and involves manually manipulating the skin, muscles and other soft tissues. Many people use massage therapy as a way to unwind, but doctors sometimes recommend it as part of an integrative medicine treatment protocol for various health conditions.
Massage therapy has several proven health benefits, including stress reduction, pain relief and improved immunity. Therefore, it's often recommended for health conditions that tend to cause pain, stress and anxiety.
Does Medicare Cover Massage Therapy?
Regular Medicare doesn't cover massage therapy because it considers it a complementary treatment. This means that you are responsible for paying for your treatment out of pocket, even if it is recommended by a doctor to treat a health condition. You should expect to pay around $60 per hour for massage therapy, but prices vary widely by region and the therapist's credentials.
However, you may be able to receive massage therapy as part of a course of medically necessary physical therapy under Medicare Part B. Physical therapists sometimes use massage alongside other techniques to help reduce pain and improve strength and mobility. Medicare Part B pays for 80% of the cost of physical therapy, minus deductibles.
Does Medicare Advantage Cover Massage Therapy?
People with Medicare Advantage health insurance may be covered for massage therapy. Medicare Advantage insurance (Part C) is provided by private insurance companies and approved by Medicare. While it provides the same basic coverage as original Medicare Parts A and B, it may extend to a wider range of treatments depending on your provider.
Since 2019, many Medicare Advantage insurers have become more flexible around funding complementary treatments. Roughly 1.5 million Medicare Advantage beneficiaries are enrolled on a plan that covers massage therapy.
Most plans will require that your massage therapy is medically necessary and prescribed by an in-network physician before they will provide coverage. You will also need to find an in-network, licensed therapist to perform your treatment.
A key thing to consider if you want health insurance that covers massage therapy is whether it's worth the cost of higher premiums. Medicare Advantage plans typically provide more comprehensive coverage than original Medicare, but they also tend to cost more. However, you may find that it's cheaper overall to pay the higher monthly premiums than cover the costs of massage therapy yourself, especially if you anticipate needing frequent treatment.
Does Medigap Cover Massage Therapy?
Medigap coverage, also known as Medicare Supplement Insurance, is designed to help you pay the portion of your health care costs not covered by your original Medicare insurance. It is only available from private insurers and may cover some or all of your financial liabilities, such as deductibles and coinsurance.
Medigap policies only cover treatments included in original Medicare Parts A and B. Therefore, it doesn't cover massage therapy because the treatment isn't included in original Medicare coverage.
If you have massage therapy as part of a physical therapy treatment program, Medigap insurance could cover some of the costs because physical therapy is included in Medicare Part B. However, new Medigap plans sold after January 1, 2020, no longer provide the Part B deductible coverage.
Does Medicare Cover Alternatives to Massage Therapy?
Although original Medicare doesn't cover massage therapy, it may cover other treatments that could offer similar benefits. Medicare Part B covers certain therapies if they're medically necessary, including some that use massage therapy during treatment protocols.
Medicare Part B covers 80% of physical therapy costs, and you'll be responsible for paying the remaining 20% and deductible. Medigap might cover the deductible if you bought your plan before January 1, 2020.
To qualify for physical therapy under your Medicare Part B coverage, it must be medically necessary. This means that it must be used to diagnose or treat a health condition.
Medicare Part B covers chiropractic treatment under very limited circumstances. It only covers manual treatment to correct a subluxation, a condition where the vertebrae become misaligned. It does not cover tests, medical imaging, massage or any other procedure carried out during chiropractic therapy.
As with physical therapy, your treatment must be medically necessary to qualify for Medicare Part B coverage. If your treatment is covered, you are responsible for paying 20% of the Medicare-approved costs and the deductible.
Medicare Part B insurance covers acupuncture for lower back pain only. To qualify, your lower back pain must be:
- Unrelated to surgery or pregnancy
- Idiopathic (no known cause)
- Persistent, lasting at least 12 weeks
Medicare part B will fund up to 12 treatments over 90 days. If your doctor believes that the therapy is improving your condition, Medicare may then pay for up to 8 extra sessions. The maximum number of sessions that Medicare will fund over a year is 20.
Your therapy must be performed by a doctor, a state-licensed acupuncture therapist or a degree holder in acupuncture or Oriental medicine to be eligible for coverage.
Self-Funding Massage Therapy
If you need massage therapy to treat a medical condition but only have Medicare Part A and B, you won't be entitled to assistance with your treatment costs. If treatment is unaffordable, it's worth finding out if your local training school offers reduced rates to allow its students to gain experience. You could also ask your doctor to recommend a foam roller or mechanical massager as a more affordable alternative to massage therapy.