There may be times in your life when you want to try alternative or more holistic approaches to your health conditions. Alternative treatments focus on stimulating the body to heal itself and preventing further health complications. Additional mental benefits can be a result of alternative treatments as well. These treatments can include massage therapy, chiropractic care, acupuncture, and dietary supplements or vitamins.
What is Medicare?
Medicare is a health insurance program for those 65 and older and for those that have specific disabilities. Original Medicare provides hospital coverage and medical coverage. The rule of thumb is Medicare will cover anything that is deemed medically necessary.
Inpatient hospital coverage falls under Medicare Part A. A semi-private room in a hospital, three daily meals, medications, and lab services are covered by Part A. After a hospital stay, Medicare Part A will also cover 100 days in a skilled nursing facility if the doctor orders additional care. You can also get home health care provided by Part A. There may be certain criteria that need to be met for Medicare to approve a service.
Medicare Part B covers approved medical services. Outpatient medical services include surgeries, doctor visits, lab work, tests, infusions, and more. Some services may require prior authorization for them to be covered, and each service may have a limit. Preventive services are also covered under Part B, such as annual wellness visits, colonoscopies, flu shots, etc.
Original Medicare leaves beneficiaries with out-of-pocket costs such as deductibles, copays, and coinsurance.
What alternative treatments does Medicare cover?
Few alternative treatments are approved and covered by Medicare currently. As more alternative treatments are tested and used, their status with Medicare could change in the future. At this time, chiropractic care and acupuncture can be covered by Medicare.
Chiropractors focus on diagnosing and treating mechanical disorders by adjusting the musculoskeletal system, specifically the spine. Medicare Part B only covers manual manipulation of the spine to correct subluxation. It would not cover massages that you may receive at a chiropractor or x-rays that are taken. The visit must be medically necessary for Medicare Part B to cover it.
Acupuncture is an alternative medicine that uses needles to stimulate the body. The needles cause the body to release chemicals and thus promote the body’s healing process. Overall positive well-being is a goal during acupuncture.
Medicare does cover some acupuncture. It can cover 12 visits within 90 days, but only for chronic low back pain. If there is improvement after the 12 visits, then Medicare can cover an additional eight visits. However, if there is no improvement, then Medicare will not cover additional visits.
Chronic low back pain must last longer than 12 weeks to be considered chronic and cannot be associated with other health conditions.
How does Medicare cover those treatments?
If Medicare approves chiropractic care and acupuncture, then the Part B deductible will apply. The deductible is an annual deductible, and in 2021 it is $203. Once that deductible is met during the year, Medicare will cover 80% of all Part B approved services.
A Medicare beneficiary with Original Medicare Part A and Part B will be responsible for the 20% coinsurance. However, if the beneficiary is enrolled in a Medigap plan, then the Medigap plan will help cover the 20% instead. If the beneficiary is enrolled in a Medicare Advantage plan, then their cost-sharing will vary based on their plan.
What if Medicare does not cover an alternative treatment?
If Medicare does not cover certain treatments or approve additional services during visits, the beneficiary can appeal the denied claim. However, the beneficiary would pay entirely out-of-pocket for the desired services that Medicare will not cover.
Medicare has extended its coverage to alternative treatments over the years. As more treatments are being used in place of traditional treatments, the status can change. Medicare is constantly reviewing services, although the process can take time. If you prefer alternative treatments and approaches, it is essential to understand how Medicare may cover them.