Medicare & Acupuncture

The Centers for Medicare & Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients with chronic low back pain.

Before this final National Coverage Determination (NCD) reconsideration, acupuncture was nationally non-covered by Medicare. CMS conducted evidence reviews and examined the coverage policies of private payers to inform today’s decision. To read the final decision, visit the CMS website at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295

Does Medicare cover dental? Does it cover eyeglasses? How about hearing aids? What about the Shingles vaccination?

If you are a Medicare recipient, you have asked these questions. If you are a Medicare insurance broker, you have heard these questions every single day of your career. There are yes and no answers to all these questions and it depends on the plan being offered.

The Shingles question is always thought provoking to me because the vaccination as of right now is not covered under Original Medicare but if you contract the condition your treatment is covered.

A lot needs to be improved regarding certain benefits but with this acupuncture decision, this is certainly a step in the right direction. In fact, you had to figure improvements regarding Medicare were coming sooner or later if you have listened to President Trump.

Since his campaigning days four years ago he has been touting that he wanted to expand options for pain treatments for the Medicare program. This has been a big promise from Trump from the beginning and this is a good first step.

From time to time I have had clients ask me if acupuncture is covered and the answer was always no. There are people who consider the practice an unusual far out alternative treatment. I have heard a lot of people praise it above anything else they have tried.

Being a sufferer of lower back pain myself I have always thought about trying it. Now that it will be considered Medicare covered, the treatment it will open a lot of doors for our senior population and the practicing physicians.

A lot of sufferers from lower back pain have tried many treatments to no avail and usually settle on prescription medicines which President Trump is trying to sway people away from especially with the opioid public health crisis in this country.

There have been studies regarding acupuncture among Medicare patients and it has shown to improve mobility and relieve pain. I personally believe it is something that everyone should try, and it may work for some and not others. But that is why I think most pain sufferers as myself do have an open mind regarding treatments.

Of course we will have to wait on the final decision from CMS as to what will exactly be covered as far as variations etc. The great news is that CMS is on board with the treatment and other ways to improve the health of our seniors.

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt. “We are building on important lessons learned from the private sector in this critical aspect of patient care.

Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.” As I read the article, I noticed the decision will cover up to 12 treatments in 90 days with an additional 8 treatments for those patients with chronic lower back pain who show improvement.

This decision alone is great news because it could open the doors for other treatments, vaccines and benefits for Original Medicare. Like I mentioned earlier, does it seem logical to cover treatment for Shingles but not the vaccination?

Why not add Silver sneakers to the program? We know exercise is the key to health and survival. Routine eye exams? Could be the key to ward off glaucoma and cataracts which are covered under Original Medicare. Just some food for thought here.

A lot of people are not well studied in alternative practices such as acupuncture. It is a form of Chinese medicine in which very thin needles are inserted into a specific body part to put pressure on the area of pain and relieve it.

It is not based on any scientific knowledge. Some of you may think, “Needles? No way, that is a treatment that I will not venture into.”

I have talked to a lot of people who swear it works and is pain free, so why not give it a go?

The worst that can happen is it does not work for you. As a lower back pain sufferer, I just talked myself into trying the treatment, although I am not a Medicare recipient.

I know this October when the Annual Enrollment Period begins this is going to be great topic of conversation. Not just the acupuncture treatment but how CMS is starting to recognize that other alternative treatments can actually have a place under Original Medicare. This is good for our senior population and for Medicare itself.

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