Key takeaways
- Medicare Part B generally does not cover acupuncture for arthritis-related pain, as coverage is limited to chronic low back pain without a known cause.
- While Original Medicare (parts A and B) may not cover acupuncture for arthritis, some Medicare Advantage (Part C) plans might offer additional coverage for this treatment.
- Medicare Part D covers medications for arthritis, and Parts A and B cover surgeries and assistive devices, respectively, offering alternative avenues for managing arthritis-related costs.
Arthritis causes inflammation in various joints. Different types of arthritis can affect different parts of your body.
Arthritis can sometimes affect your back. In this case, it’s called lumbar or spinal arthritis.
Even if you’ve received a diagnosis of arthritis and it’s causing lower back pain, Medicare isn’t likely to cover acupuncture as a treatment.
If you’re experiencing lower back pain that isn’t caused by any identifiable condition or illness, Medicare Part B will pay for up to 12 acupuncture treatments every 3 months. In order to get coverage, you must have experienced the pain for at least 12 weeks.
After your initial acupuncture treatments, Medicare will pay for another eight sessions if there’s evidence of improvement in your pain. If there’s no improvement, Medicare will no longer cover this treatment.
This does not apply to back pain caused by arthritis, though. Arthritis is an inflammatory disease that counts as an identifiable cause.
Even when acupuncture is covered, a qualified and licensed medical practitioner who accepts Medicare must perform the treatment. And because Medicare doesn’t pay acupuncture professionals directly, you’ll have to pay out of pocket and then request reimbursement for the cost from Medicare.
According to the Arthritis Foundation, the cost of acupuncture ranges between $75 and $200 per session. Although Original Medicare won’t pay for acupuncture for arthritis, you have some options that may help you reduce the cost.
If you qualify for Medicaid, it may offer coverage in some states.
In addition, you could look into a Medicare Advantage (Part C) plan. While Advantage plans must provide the same coverage as Original Medicare (parts A and B), they are operated by private companies and may offer additional coverage options.
You’ll need to search the available plans in your area and call the plan provider to determine whether acupuncture is covered and under what conditions.
Acupuncture is a form of traditional Chinese medicine that has been used for thousands of years. It involves inserting fine needles into pressure points along the body to promote relaxation and increase blood flow by removing blockages in the body’s energy.
Medications to treat arthritis should be paid for by Medicare Part D, which covers prescription drugs. However, the drug must be listed on the Part D formulary.
A formulary is a list of covered medications that classifies drugs into various levels, or tiers. Your out-of-pocket expenses will vary depending on the tier the drug falls under.
Certain Medicare Advantage plans may also offer drug coverage.
If you need surgery, Medicare Part A will typically cover it. If you need any assistive devices, like a cane or a splint, this will fall under Part B. In addition, Part B also pays for pain management and chronic care management if you live with two or more chronic conditions, one of which can be arthritis.
Some Medicare Advantage (Part C) plans may cover more than what’s offered by Original Medicare (parts A and B).
You can also consider purchasing Medigap, which is supplemental insurance, to help offset any deductibles or premiums. But you’ll have to choose between Medigap and Part C because you can’t have both at the same time.
Medicare won’t pay for acupuncture for arthritis treatment. Acupuncture is covered only when used to treat chronic lower back pain from an unidentifiable cause.
However, other Medicare Advantage plans may offer additional coverage. Medicare can also pay for other arthritis treatments, such as medications, assistive devices, and surgery.