When Does Medicare Cover Acupuncture?
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Original Medicare and Medicare Advantage, along with Medicare Supplement (Medigap) policies, cover acupuncture. Medicare limits the number of acupuncture sessions you can get and who can provide those services.
Medicare Advantage usually has low-cost plans with the same or better acupuncture coverage than Original Medicare. This makes Medicare Advantage plans — particularly HMOs — our choice for best overall value.
Does Medicare cover acupuncture?
Medicare covers acupuncture only for chronic low back pain, which the agency defines as:
- Pain not associated with surgery or pregnancy
- Having no known cause (for example, not related to cancer that has spread, inflammation or infectious disease)
- Lasting 12 weeks or longer
You have coverage for up to 12 acupuncture visits in 90 days. Medicare will cover eight more sessions if you show improvement. That means you can have up to 20 acupuncture treatments in a calendar year. But if the treatment isn't helping or your condition is getting worse, Medicare won't cover the extra acupuncture services.
Remember that Medicare doesn't cover acupuncture for any condition other than chronic low back pain.
What type of acupuncture provider can you use with Medicare?
For Medicare to cover acupuncture, you have to get treatment from a health care professional. This includes doctors, nurse practitioners or physician assistants. Spas or acupuncture studios without those certifications aren't covered. Your provider has to have both:
- A master's or doctoral-level degree in acupuncture or East Asian Medicine from a school accredited by the Accreditation Commission for Acupuncture and Herbal Medicine
- A current, full, active and unrestricted license to practice acupuncture in the state where care is being provided
Before getting treatment, be sure your acupuncturist is an approved provider. Your family doctor may be able to help you find one who meets Medicare requirements.
How much does Medicare pay for acupuncture?
Medicare pays 80% of the approved amount for your acupuncture services. If Original Medicare is your only coverage, you'll pay the remaining 20% after meeting your deductible.
Say your acupuncture provider typically charges $200 for an acupuncture treatment. But the provider signed an agreement to accept Medicare's approved amount for the service, or $100. After Medicare pays its portion, you pay the balance of 20%, or $20.
Medicare-patient cost breakdown (after the Part B deductible is met)
| Acupuncture treatment cost, as agreed to by Medicare and the provider | $100 |
| Portion of the bill covered by Medicare | 80%, or $80 |
| Your out-of-pocket cost | The remaining 20%, or $20 |
Medical offices that take Medicare usually charge less for their services than they would otherwise. When you use a participating provider, your portion of the cost is based on that lower amount. This lowers your final payment and saves you money in the end.
How do Medigap plans cover acupuncture?
Medigap plans "fill the gap," or address costs left over after Medicare pays.
With Original Medicare, you have to pay the Part B deductible first. After that, you have to pay 20% of the Medicare-approved amount for medical services, including acupuncture. This is called coinsurance. But Medigap plans cover some or all of what you owe (your 20%), depending on the policy.
For example, Plan K pays just 50% of your cost, and Plan L covers 75%. Plan N charges a copay instead of coinsurance. But the other Medigap plans pay your coinsurance amount in full.
If Medicare rejects a claim, Medigap will not cover any of the cost and you will be responsible for the full amount.
The example below shows your out-of-pocket expense for an acupuncture service after you've met your deductible. In this example, the charge for acupuncture was $100. Medicare paid 80% of that amount, or $80, to the participating provider.
With Medigap, your portion of the remaining $20 would be the following:
Medigap plan | Your cost |
|---|---|
| Plan A | $0 |
| Plan B | $0 |
| Plan C | $0 |
| Plan D | $0 |
| Plan F | $0 |
| Plan G | $0 |
| Plan K | 50% coinsurance, or $10 |
| Plan L | 25% coinsurance, or $5 |
| Plan M | $0 |
| Plan N | $0-$20 copay |
Does Medicare Advantage cover acupuncture?
All Medicare Advantage plans cover acupuncture for chronic low back pain as required by Medicare. Some Medicare Advantage companies, like Kaiser Permanente, cover acupuncture for nausea or general chronic pain in addition to the minimum benefit required by Medicare.
Medicare Advantage HMO plans might require you to get approval for acupuncture or a referral by your family doctor. With an HMO, you'll also likely need to use an in-network doctor.
Medicare Advantage provider | Benefit level | Member cost |
|---|---|---|
| AARP/UnitedHealthcare (UHC) | Coverage for chronic low back pain only | $30 copay per Medicare-approved visit |
| Aetna | Coverage for chronic low back pain only | $35 copay per Medicare-approved visit |
| Blue Cross Blue Shield (BCBS) | Coverage for chronic low back pain only | $20 copay per Medicare-approved visit |
| Cigna | Coverage for chronic low back pain only | $20 copay per Medicare-approved visit |
| Humana | Coverage for chronic low back pain only | $35 copay per Medicare-approved visit |
| Kaiser Permanente | Coverage for chronic low back pain, nausea or as part of a program for other chronic pain | Between $0 and $10 per visit depending on where you live or if you're a Medicare Part B-only member |
Best Medicare managed care options for acupuncture
A few HMO plans stand out based on cost, extra benefits or availability.
What if I need acupuncture that is not covered by insurance?
If you don't have coverage for acupuncture, you might still be able to get acupuncture at a low cost.
- Discuss payment options with your provider prior to your appointment. They may negotiate service fees or offer to adjust your bill based on your income.
- Alternative medicine colleges might offer treatment from students or interns at reduced rates. Some colleges run community clinics that provide free or low-cost services.
- Look for a community acupuncture center in your area. Your rate might be based on income.
Frequently asked questions
When did Medicare start covering acupuncture?
Medicare began covering acupuncture in early 2020 partly as an alternative to prescription medications — particularly opioids — for low back pain management.
What acupuncture providers are approved by Medicare?
Medicare covers acupuncturists who have a master's or doctoral-level degree in acupuncture or East Asian Medicine from a school accredited by the Accreditation Commission for Acupuncture and Herbal Medicine. They also have to have a current, full, active and unrestricted license to practice acupuncture in the state where care is being provided.
If you're not sure how to find an approved provider, your family doctor may be able to help. You also can search Medicare.gov to find participating providers near you.
Does Medicare cover both chiropractic and acupuncture care?
Yes, Medicare Part B covers both acupuncture and chiropractic care. Be sure to ask your insurance and medical providers about your coverage before making an appointment.
Methodology
ValuePenguin's recommendations are for plans that offer good acupuncture benefits and overall value. Most states offer plans from large insurance companies, like AARP/UnitedHealthcare and Blue Cross Blue Shield.
Medicare quotes and plan details are from AARP/UnitedHealthcare, Aetna, Blue Cross Blue Shield, Cigna, Humana and Kaiser Permanente. Other sources include Medicare.gov and CMS.gov.
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