Insurance Coverage on Acupuncture

Understanding Health Insurance: June 28, 2015 - Medicare, chiropractic care, and acupuncture

Does Medicare cover chiropractic care or acupuncture? Chiropractic care is covered by Medicare, but there are some limitations. If you type "chiropractic care" into the search field on the Medicare website under "is my test, item or service covered?" it will tell you that Medicare Part B covers manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.

It further informs you that this coverage is extended to all people covered by Medicare Part B. You will pay 20 percent of the Medicare-approved amount after Medicare pays 80 percent of the approved amount, and the Part B deductible will apply if you have not already met it for the year. You will pay the full cost of other services and tests ordered by the chiropractor such as x-rays and massage therapy. Keep in mind, most Medicare supplements pay the 20 percent.

Also be mindful of whether your chiropractor accepts assignment. If he/she accepts assignment, it means he/she can only bill you up to the amount Medicare approved. In this case, you would only be responsible for the 20 percent of the approved amount, and if you have a Medicare supplement that covers the 20 percent, you will be made whole. If your chiropractor does not accept assignment, he/she can bill you up the amount originally charged. In this case, you are responsible for the 20 percent plus the difference between the amount approved, and originally charged. Again, depending on what Medicare supplement you have, this additional amount may be covered.

However, there are limitations which are not so easily defined. It is important to keep an open dialogue with your chiropractor’s office if you do not wish to be surprised by bills at some point. If you have hit against a limitations threshold, the chiropractor may be able to appeal to Medicare and substantiate that you are responding to treatment, but that more sessions are required to achieve the desired goal. Medicare will then review the information and make a determination as to whether or not more sessions will be approved for you.

Acupuncture is not covered by Medicare. If you are Medicare eligible and want to have acupuncture, you can certainly do so. However, Medicare will not cover the cost of the treatment and you can anticipate paying the entire expense out of your pocket.

Betsy Chandler is a licensed insurance professional with MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call 973-492-2828.

The source of this report is here.