Does Medicaid Cover Acupuncture?

Acupuncture is a great treatment for all kinds of aches and ailments, and many people will swear by it as their go-to treatment for a range of issues.

However, acupuncture sessions can be expensive, so let’s find out if Medicaid is willing to help cover the cost so you can get back to your normal self in no time. 

Does Medicaid Cover Acupuncture? 

Yes – Medicaid does indeed cover the costs of acupuncture treatments but this varies from state to state. Right now, the only states which provide Medicaid-covered acupuncture services are: 

Prior to 2020, Medicaid did not cover acupuncture services at all but now they are available.

However, there are a lot of rules in place and criterias the patient needs to meet before Medicare will greenlight covering their acupuncture treatments costs. 

And even then, Medicaid may not even cover the full cost of your acupuncture treatment. 

This is because acupuncture services come under Medicaid Part B, which means that Medicaid will only cover the cost of medical services if they are deemed medically necessary.

Usually, this covers things like tests and exams but acupuncture services also fall in this category. 

To receive Medicaid Part B cover, you will need to pay a monthly premium fee.

When Will Medicaid Cover Acupuncture Services?

Because acupuncture services fall under Medicaid Part B, this means that Medicaid will only cover the cost of your acupuncture treatments if they are deemed ‘medically necessary’.

This means that if other treatments have failed to help with your ailment and your doctor decides you should try acupuncture, then Medicaid will help cover the cost of your sessions. 

Also, Medicaid will only cover acupuncture treatments for lower back pain so if you wanted to try and use Medicaid to help fight other ailments such as fertility issues, migraines, or dental pain, then you will be out of luck. 

The reason behind this is because for many years Medicaid and Medicare refused to class acupuncture as an effective type of treatment.

Despite the fact that it has been used around the world for centuries to help treat all sorts of ailments, Medicaid and Medicare both refused to see it as a legitimate and valuable source of treatment. 

That is, until a report in 2016 raised concerns about the amount of people suffering from lower back pain who were being given opioid medications as treatment.

Opioids

Opioids are a type of pain relief medication that can also be very addictive which means that all those people being given opioids as treatment for their frequent back pain were increasing their risks of drug abuse and becoming reliant on their medication. 

Due to this concern around the overuse of opioids, Medicare and Medicaid began greenlighting safe alternative treatments to reduce the amount of people using opioids for back pain treatment.

This is why only those with lower back pain can access acupuncture services covered by Medicaid – because the alternative would be a very risky form of painkiller. 

So, if you live in a state where the Medicaid Part B covers acupuncture and you want Medicaid to cover your acupuncture treatments, they only will if it is for lower back pain and it has been deemed medically necessary by your doctor or physician.

However, there are still ways you can have your acupuncture treatment covered if you live in other states and that way is through Medicare. 

Does Medicare Cover Acupuncture?

While Medicaid has been a lot slower uptaking acupuncture as an effective form of treatment for lower back pain, Medicare has not.

However, like with Medicaid, they have put a few measures in place to restrict who gets their acupuncture treatments covered by their Medicare. 

Medicare will only cover acupuncture treatments for those suffering from lower back pain with no known source (just like with Medicaid).

This means that if your lower back pain is likely to be caused by another ailment or condition, such as pregnancy or cancer, then you will not be covered by Medicare for your acupuncture treatments. 

Your acupuncture sessions will also only be covered if they are carried out by someone with a master’s or doctorate level of training (such as a doctor, nurse practitioner, or healthcare professional) in the field of acupuncture.

They also need a state license to practice acupuncture, otherwise Medicare will not cover the cost of these sessions.

Also, Medicare will only cover up to 12 acupuncture sessions within a 90 day period. If your symptoms improve after this, then you will be entitled to a further 8 acupuncture sessions.

This means that you will only be able to have a total of 20 free acupuncture sessions over a full year. After that, you will have to pay for any further sessions yourself. 

Costs

The average cost of a single acupuncture session can range from $50 to $70, so it’s very easy to see why so many people want their Medicaid and Medicare to cover these costs – especially if they are effective.

So, you may be better off trying to switch to Medicare if you can so your acupuncture treatment is more likely to be paid for you.

If you are ‘dual eligible’ for both Medicaid and Medicare, then you can enroll in the Special Needs Plan so you can enjoy the benefits of both. 

Conclusion

So, technically, Medicaid does cover the cost of acupuncture treatments but there are so many limitations in place that not many people actually have access to free acupuncture treatments.

This is because so few states offer this type of treatment under their Medicaid, and they only cover it for treatment for lower back pain. 

However, the future is bright for acupuncture and Medicaid – the reaction to the 2016 report concerning opioid use under Medicare and Medicaid means that it is likely that more and more states will be looking to include safer alternative treatments to their Medicaid services.

So, we may see more states offer acupuncture under their Medicaid services in the future – even though it is very likely to only be for lower back pain treatment. 

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