Original Medicare (Part A and Part B) does not cover either acupuncture or acupressure. This is the case, even if these services have been performed by a physician or other health care provider whose services are otherwise covered by Medicare (meaning that these providers accept Medicare assignment). This means that Medicare beneficiaries who have Medicare Part A and Part B must pay the full cost of any type of acupuncture and / or acupressure services that they receive.
Acupuncture is considered to be an “alternative therapy” that has not been scientifically proven to be effective as either an analgesic, anesthetic, or for other therapeutic purposes, per the Centers for Medicare and Medicaid Services. Therefore, it is up to Medicare beneficiaries to pay 100 percent out-of-pocket for their care when obtaining this type of service.
In some cases, a Medicare Advantage plan may provide some coverage for acupuncture. Medicare Advantage plans – also referred to as Medicare Part C – provide an alternate method for Medicare beneficiaries to receive their Medicare Part A and Part B coverage. These plans also typically provide additional benefits that are not generally included in Original Medicare, such as vision and dental coverage. In some cases, depending on the specific plan that is purchased, acupuncture and / or acupressure services may be covered.
In many cases, however, it will typically be required that in order to be covered by Medicare Part C, the care must still be considered medically necessary. This means that the care must either be ordered or prescribed by the Medicare enrollee’s licensed physician or other authorized provider. In addition, the Medicare Advantage plan must also agree that the care is both proper and necessary.
Also, the care must be performed or delivered by a health care provider who accepts Medicare assignment. Unless all of these criteria are met, it is not likely that the care will be covered by a Medicare Part C plan.
In order to find out how much your Medicare plan will cover for acupuncture – if any – it is important to consult first with your doctor or other health care provider. This is because there are many different criteria that can affect how much you may have to pay. These include any other insurance that you may have, the type of services that you receive, where you receive your services, and whether or not your services are considered to be medically necessary.
If you will not be provided with coverage for the type of care that your doctor or health care provider is prescribing, it may be possible to consider an alternate type of care that will be covered in full or in part by Medicare or by a Medicare Advantage (Medicare Part C) plan.