Medicare policies may cover acupuncture

As many medicare beneficiaries opt out of straight medicare to go with an alternative insurance, acupuncture benefits are more and more creeping into what is covered.  Let me back up for those of you unfamiliar with medicare plans….

First of all, medicare does NOT cover acupuncture.  When you become medicare aged, you have the option of keeping straight medicare OR opting out of it, and going with another insurance in it’s place.  So, whatever monies the government pays for a person for medicare, they instead pay the health insurance.  Many insurance companies now have Senior plans which can replace traditional medicare.  In doing so, some may now offer acupuncture coverage.  For along time, most did not.  But starting this year, more have added acupuncture as a benefit.  As always , call and verify a persons coverage. 

In many other cases, however, and this is where it can get confusing, someone has a SUPPLEMENTAL insurance.  This means that they have medicare and a secondary insurance, 9 times out of 10 it ONLY covers what medicare allows, pays the patients deductibles and co-pays, etc.  Since medicare doesn’t cover acupuncture, neither would a supplemental.  So, this would be the first question on a call to a medicare aged patient’s insurance, IS THIS SUPPLEMENTAL TO MEDICARE or is this policy in lieu of medicare benefits and, if so, are there acupuncture benefits. 

I thought it was important to mention this, I know it can be confusing, but I’ve seen more insurance covering acupuncture for patients aged 65 and older and so I wanted to put that out there. I’m expecting questions regarding this…

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2 Responses to Medicare policies may cover acupuncture

  1. mdixon1982 says:

    I am one of those people that has both medicare and supplemental insurance; my supplemental insurance is Blue Shield. I think there was a time–maybe three years ago–when my insurance did cover a percentage of the cost of acupuncture. However, I think that was when Blue Shield was my primary and Medicare was secondary. Because of certain laws in California, after a certain amount of time Medicare must become primary. When that happened, Blue Shield only covered the same procedures as Medicare (in most cases) and Blue Shield would no longer cover any cost of acupuncture. I would really like to try acupuncture again, but I cannot afford to pay for the full cost out of pocket. It would be great to find out how I can utilize my two insurances so that the procedure would be covered. Is there a way to bill these types of insurances for acupuncture if the treatment has been pre-approved? I would have to look into my coordination of benefits to see if there are any loopholes that allow coverage (ie. doctor has tried all other forms of therapy without success). I noticed that you have offices in Encinitas and other parts of San Diego. I’m in Oceanside so I’m relatively close. If you have any advice regarding ways to receive acupuncture coverage (even if it is partial) I would appreciate it.

  2. AcupunctureForUSA says:

    Things have changed in 2015. Traditional Medicare policy with a supplemental policy may get reimbursed for their acupuncture service provided the secondary policy has acupuncture as a listed benefit. There is, however, a catch at the time the provider submits the claim to the secondary insurer to get paid though.

    – Jim @ Acupuncture For USA

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