Medicare Says I Have Acupuncture Benefits. Is That True?

Seniors are increasingly drawn to acupuncture due to its holistic and patient-centered approach to healthcare. One significant factor is the prevalence of chronic pain and age-related conditions among the elderly population. Acupuncture offers a drug-free alternative for pain management, which resonates with seniors seeking to minimize their reliance on prescription medications and their potential side effects.

The acceptance of acupuncture within the framework of Medicare signifies a significant shift in the recognition of alternative therapies as valid and valuable components of healthcare.

Additionally, the devastating opioid and OxyContin crisis played a pivotal role in reshaping public opinion and healthcare policies. As the detrimental effects of opioid medications became increasingly apparent, there was a pressing need for safer and non-addictive pain management options. Acupuncture, with its potential to alleviate pain without the risks of addiction and adverse side effects, emerged as a viable solution.

USING YOUR MEDICARE BENEFITS

But now you are trying to use your benefits and you are finding it’s not that straight forward. So, what does it mean if Medicare covers acupuncture benefits?

Medicare includes a provision for 12 acupuncture sessions for low back pain, providing enough visits to explore the potential benefits of this alternative therapy. An extra 8 acupuncture sessions are allowed if the beneficiary shows improvement. The result is a total of 20 sessions.

That sounds good. So, what’s the hitch?

Medicare does not allow individuals professionally trained and licensed in acupuncture on Medicare’s insurance panel. An insurance panel is a limited group of providers who agree to work within the boundaries established by an insurance company. By agreeing to work within the insurance boundaries, providers can be reimbursed by the insurance company when they provide patient care services to enrolled beneficiaries. Medicare will not reimburse for services if a provider is not on the panel.

That means Medicare will not reimburse individuals trained in acupuncture under the current rules. For most seniors, that means you have acupuncture benefits. You just can’t use them.

MEDICARE ADVANTAGE – HOW THEY TRY TO SWEETEN THE POT

There is a nuance to these benefits. When you initially sign-up for Medicare, you can sign-up for Medicare or Medicare Advantage. Some insurance companies offering Medicare Advantage plans are sweetening the pot.

The supplemental for the Advantage plans can include additional acupuncture benefits over the Medicare provision. By adding an additional benefit over the Medicare benefit, the insurance companies can allow a different panel of providers to provide services. Each insurance company has a panel of providers for their non-Medicare plan that has acupuncturists on panel. If your acupuncturist is on that panel, the insurance company will reimburse services to the provider instead of Medicare.

The Advantage programs are cheaper, and their supplementals are cheaper. But, they are cheaper for a reason. You usually only figure out why once you have a significant medical event and learn the number of visits for physical therapy or other things is reduced.

I love that the Medicare Advantage plans are offering alternative care benefits you can use. I’m very cautious as I learned that corporations usually don’t give something for nothing. They may offer you these benefits because the insurance company more than reclaims the few dollars they paid in alternative care benefits by reducing the quantity of benefits from Medicare standard.

Another catch is some of these plans use a co-insurance benefit instead of a co-pay. Co-insurance requires you to pay a percentage of the visit. That can make the visit significantly more expensive for you.

It can be difficult to figure out the co-insurance because some insurance companies put their Advantage plans on different reimbursement rates. If the company slow pays, it may be months before you find out your share. What if it’s more than either you or the provider were expecting? The risk of incurring too large a medical bill can prevent you from using your benefits.

The lesson is to be careful of shiny, cheaper, new toys. They may be built with different quality.

HOW TO MAKE A CHANGE

I encourage individuals who recognize the potential benefits of acupuncture and its positive impact on healthcare to consider taking an active step. Writing to your Senator or House of Representatives can be a powerful way to voice your support for introducing legislation allowing acupuncturists to be included on the Medicare panel. By expanding the range of healthcare professionals available to Medicare beneficiaries, we can offer a more comprehensive and diverse set of options for managing health and well-being. Your letter can highlight the growing body of evidence supporting acupuncture’s effectiveness, its contribution to pain management, and its alignment with the shift towards holistic healthcare. Your call for action can contribute to a more inclusive healthcare system that truly addresses the needs and preferences of the population.