When Does Medicare Cover Acupuncture?
Find Cheap Medicare Plans in Your Area
Acupuncture is covered by two types of Medicare insurance plans — Original Medicare and Medicare Advantage — along with Medicare Supplement (Medigap) policies. Medicare limits the number of acupuncture sessions you can receive and who can provide those services.
When comparing how each option covers acupuncture, Medicare Advantage generally offers lower cost plans with the same or better 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 are covered for up to 12 acupuncture visits in 90 days. Medicare will cover eight additional sessions if you show improvement, which means you can receive up to 20 acupuncture treatments in a calendar year. If your doctor decides the treatment is not 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 your services to be covered, you must get acupuncture from a doctor or other health care provider (like a nurse practitioner or physician assistant) who has these two qualifications:
- A master's degree or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission for Acupuncture and Oriental 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 |
Medicare-participating providers agree to accept payment that is usually lower than their regular charge for a service or procedure. When you use a participating provider, your portion of the cost is based on that lower amount. This reduces 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. Once you meet the Medicare deductible, you are responsible for coinsurance of 20% of the Medicare-approved amount for medical services, including acupuncture. 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%. All other Medigap plans pay your coinsurance amount in full, except for Plan N which charges a copay rather than coinsurance.
It's important to remember that 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. This scenario assumes that Medicare approved a charge of $100 and 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 insurers, such as Kaiser Permanente, provide acupuncture for nausea or general chronic pain in addition to the minimum benefit required by Medicare.
Medicare Advantage HMO plans, like those listed here, may require preauthorization for acupuncture or a referral by your family doctor. With an HMO, you'll also likely need to use an in-network acupuncturist.
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 plus acupuncture for nausea or as part of a comprehensive 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
Of the Medicare HMO plans we reviewed, the below plans stood out as top options for factors such as cost, additional benefits or availability.
What if I need acupuncture that is not covered by insurance?
If your acupuncture is not covered by insurance, check into these options for getting affordable treatment in your area:
- Discuss payment options with your acupuncturist prior to your appointment. They may negotiate service fees or offer to adjust your bill based on your income.
- Alternative medicine colleges often offer treatment from students or interns at reduced rates, and some colleges run community clinics that provide free or low-cost services.
- Look for a community acupuncture center in your area, where rates are often 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 degree or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission for Acupuncture and Oriental Medicine 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, both acupuncture and chiropractic care are covered under Medicare Part B. Be sure to check with your insurance and medical providers for coverage information before making an appointment.
Methodology
Our policy recommendations are based on selections that offer good acupuncture benefits and overall value. Some plans, such as AARP/UnitedHealthcare and Blue Cross Blue Shield, are offered in most states so are widely accessible. Medicare quotes and plan details were sourced from AARP/UnitedHealthcare, Aetna, Blue Cross Blue Shield, Cigna, Humana and Kaiser Permanente. Additional sources include Medicare.gov and CMS.gov.
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