WHAT'S WAPPENING?

New Acupuncture Benefits for Medicare Enrollees

Posted by Paul Rose on 2/27/20 1:38 PM

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Are your clients interested in acupuncture? For a long time, the popular procedure was not covered under Original Medicare. A new announcement from CMS reveals that this is changing. Medicare will start covering acupuncture in certain situations.

What Is Acupuncture?

Acupuncture is a traditional Chinese technique used to relieve pain. Thin needles are inserted into the skin at specific points in order to produce a healthful energy flow.

Although the practice has its skeptics, John Hopkins Medicine states that studies have shown acupuncture to be effective when used for a variety of conditions. Studies from the National Institutes of Health have found that acupuncture is effective in treating low back pain, headaches, carpel tunnel syndrome, osteoarthritis and several other conditions.

What Will Medicare Cover?

Until recently, Original Medicare offered no coverage for acupuncture treatment. Beneficiaries were responsible for 100 percent of all acupuncture costs.

However, this is changing. This January, CMS announced that Medicare would cover acupuncture for chronic low back pain. Under the new rule, beneficiaries will have access to coverage for up to 12 sessions in 90 days, and patients who demonstrate improvement may eligible for an additional eight sessions.

Why Is This Change Important?

Opioid addiction has reached a crisis point. In 2017, 47,600 overdose-related deaths occurred. Many addictions begin with opioid prescription drugs ordered by a doctor to treat pain.

To combat the opioid crisis, the federal government has taken steps to reduce the overuse and abuse of opioid prescription drugs. Since 2017, there has been 31 percent decrease in the total opioids dispensed by pharmacies.

The new decision to provide coverage for acupuncture is part of the ongoing effort to fight opioid addiction. HHS Secretary Alex Azar said, “Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis.”

Coverage Under Medicare Advantage

Although NIH studies have found acupuncture to be effective in treating a number of health conditions, CMS has only approved coverage for low back pain. If the program is successful, it is possible that CMS will decide to expand coverage in the future, but for the time being, acupuncture benefits are very limited under Original Medicare.

Medicare enrollees may find additional acupuncture benefits through Medicare Advantage plans. Many Medicare Advantage plans offer benefits in addition to those offered by Original Medicare, such as dental and vision benefits. Although coverage details vary from plan to plan, some of these plans may provide coverage for acupuncture for conditions other than chronic low back pain.  

If your clients are looking for an alternative to opioid prescriptions, they may want to look for plans with robust acupuncture coverage.

Topics: New acupuncture benefits for Medicare enrollees, acupuncture

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