Alternative medicine is described as medical treatments that are used instead of traditional therapies. For example, instead of a doctor prescribing you medication for migraines, your doctor might prescribe you medical marijuana. More than half of adults in the United States say they would use some form of alternative medicine over traditional medicine, according to WebMD.
Medicare covers services approved by the Food and Drug Administration (FDA) for specific medical conditions. With that said, most alternative medicines are not FDA approved, so, therefore, not approved by Medicare. So, does Medicare cover alternative medicine?
Medicare and acupuncture
Medicare covers any medical service that is deemed medically necessary, and until the year 2020, acupuncture was not considered medically necessary by Medicare. However, on January 21, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized the decision to consider acupuncture medically necessary to be covered by Medicare.
However, Medicare only covers acupuncture when it is used to treat chronic lower back pain. Chronic lower back pain generally lasts for at least 12 weeks and is caused by an unknown source. You can receive up to 12 acupuncture sessions within three months when Medicare approves it.
If you begin to show improvements due to the acupuncture treatment, Medicare may cover an additional eight sessions. However, the maximum amount of acupuncture sessions you can have in a year is 20. You may be able to receive more covered treatments the following year.
Will Medicare cover a chiropractic visit?
It is common for seniors to begin to experience back and neck pain in their golden years. In fact, 16 million adults experience persistent back pain. Medicare Part B does cover some chiropractic services if it’s deemed medically necessary.
An example of a medically necessary chiropractic service is manual manipulation for subluxation. Medicare Part B covers manual manipulation of the spine to correct a subluxation, a medical condition where the bones in your back or neck are out of position.
When you visit a chiropractor for subluxation, Medicare will not cover x-rays or massage therapy provided by the chiropractor or faculty member.
Does Medicare cover medical marijuana?
If you experience insomnia, glaucoma, or headaches, your doctor may prescribe you medical marijuana in the form of alternative medicine. Although more than 30 states grant their citizens access to medical marijuana, Medicare does not cover it.
The Food and Drug Administration has not approved marijuana for medical use, as cannabis is still classified as a Schedule I controlled substance. It is unlikely that Medicare will ever cover marijuana unless there are changes made by the FDA.
There are some Medicare Advantage and Part D plans that cover other cannabinoids, such as Dronabinol. Dronabinol is a form of cannabis that helps enhance weight loss and loss of appetite when dealing with an illness. Dronabinol also can improve nausea and vomiting when you receive cancer treatments.
If you have a Medicare Advantage or Part D plan, check your plan’s drug formulary to see if Medicare covers Dronabinol, as the FDA approves Dronabinol.
Medicare costs for alternative medicine
If Medicare covers your alternative medicine, you will first pay the Part B deductible before Medicare provides cost-sharing. The Part B deductible in 2021 is $203. Once you have met the Part B deductible, Medicare will pay for 80% of your Medicare-approved service, leaving you with the remaining 20% coinsurance. However, if you have a Medigap plan, you will pay little to no out-of-pocket costs.
For example, suppose you have Medigap Plan G, and you receive a medically necessary acupuncture treatment. In that case, Medicare will pay 80%, and your Plan G will pay 20% after you have paid the Part B deductible. Therefore, leaving you with no out-of-pocket costs.
Now, every Medicare Advantage plan is different regarding its coverage. You will want to check your plan’s Summary of Benefits to know what services your plan covers and how much cost-sharing the plan will provide for your services.
While Medicare continues to better its coverage and guidelines, there are still many forms of alternative medicines that Medicare will not cover. However, Medicare keeps its rules and regulations up to date, so just because Medicare doesn’t cover something at the moment doesn’t mean it will not cover it indefinitely. In the meantime, continue to check your plan and drug formulary to see if Medicare will cover a service you need.