Medicaid may cover acupuncture in some states as an optional benefit. But because acupuncture is not a mandatory Medicaid benefit, it may not be covered in all states.
Each state has two sets of Medicaid benefits: those that are required by the federal government to be offered (mandatory) and those that the state chooses to offer on its own (optional).
Acupuncture is not part of the federally mandated set of benefits, so it is up to each individual state to decide whether acupuncture will be covered by Medicaid. Currently, only a small handful of state Medicare programs include acupuncture coverage.
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Acupuncture was not covered by Medicare until 2020, when the program determined that acupuncture can be a safe alternative to prescription medications, and covering acupuncture may assist in the fight against the nation’s opioid epidemic. Acupuncture for lower back pain is now covered by Medicare Part B and all Medicare Advantage (Medicare Part C) plans.
The Medicare program is administered the Centers for Medicare & Medicaid Services (CMS). With the CMS opening the door for Medicare to cover acupuncture, the case for doing the same for Medicaid becomes stronger.
Ohio became one of the latest states to add Medicaid acupuncture benefits, doing so in 2019 and joining New Jersey, Minnesota, California, Oregon and Massachusetts. Other states such as Vermont, Delaware and Maine have recently or are currently considering adding an acupuncture Medicaid benefit.
Medicaid beneficiaries who are “dual eligible,” or eligible for both Medicaid and Medicare, may have the opportunity to enroll in a Dual-eligible Special Needs Plan (D-SNP). A Special Needs Plan is a certain type of Medicare Advantage plan with benefits that are tailored to a specific health condition or circumstance. Dual-eligible Special Needs Plans are designed specifically for those on both Medicaid and Medicare and may include coverage for acupuncture.
Some Medicaid beneficiaries may also be eligible to enroll in a Medicaid managed care plan. These plans deliver traditional Medicaid benefits along with some additional benefits through a partnership with managed care organizations.
According to CostHelper.com, an acupuncture session may cost anywhere between $50 and $70 for a routine visit. Initial visits, which generally include a consultation, may cost an additional $25 to $45.
You can contact your state Medicaid program directly to find out whether Medicaid covers acupuncture where you live.
If you are eligible for Medicare, speak to a licensed insurance agent to find out if Dual-eligible Special Needs Plans are available in your area and how they might cover acupuncture and other benefits.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
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