Medicare Coverage for Massage Therapy: Detailed Information and Cost Implications
In the realm of healthcare, understanding what is and isn't covered by insurance can be a complex task. When it comes to Medicare, the federal health insurance programme for individuals aged 65 and over, or those with certain disabilities, the coverage options for alternative treatments like massage therapy may not be immediately clear.
Original Medicare, comprising Part A (hospital insurance) and Part B (medical insurance), does not cover massage therapy as a standalone service. This means that individuals enrolled in Original Medicare are responsible for 100% of the treatment costs.
However, the landscape changes when we delve into Medicare Advantage (Part C) plans. These private insurance options, offered by companies like Aetna and SCAN Health Plan, may cover massage therapy under specific conditions.
Aetna Medicare Advantage plans typically cover massage therapy when it is part of a physician-prescribed treatment plan and provided by an approved provider. This means that massage therapy must be medically necessary and prescribed by a doctor to be covered.
SCAN Health Plan offers a routine therapeutic massage benefit through American Specialty Health (ASH) for most of its plans. This is a self-referred benefit, meaning you do not need a doctor’s referral. You schedule an appointment with an ASH provider contracted with SCAN, receive an exam, and if more treatment is needed, a treatment plan is submitted for approval to continue care.
Many other Medicare Advantage plans may include massage therapy as part of their expanded wellness or supplemental benefits. Coverage is often limited and differs by plan, with some plans integrating it into physical therapy, chiropractic care, or broader wellness programs.
Key conditions across plans include massage therapy usually being medically necessary and part of a prescribed treatment plan (especially for plans like Aetna), some plans allowing self-referral without a doctor’s prescription but requiring initial evaluation and approval through their provider network, and coverage scope, provider networks, and number of covered sessions varying. Checking the Evidence of Coverage or contacting the plan directly is important for details.
Medicare Advantage plans are not the only options for those seeking massage therapy coverage. Medicaid, a programme that helps pay many out-of-pocket healthcare costs, may cover massage therapy costs. The Qualified Medicare Beneficiary (QMB) program, which helps people with limited incomes meet their Medicare costs, is included in Medicaid and also provides Extra Help, a programme that assists with drug costs under Medicare Part D.
It's essential to note that if a person has Medicare Advantage, they cannot also have a Medigap plan, which pays 50% to 100% of parts A and B out-of-pocket costs, such as coinsurance, copays, and deductibles.
In addition to massage therapy, Original Medicare covers physical, occupational, and speech therapy, and under certain circumstances, acupuncture and chiropractic treatment. Preliminary research suggests that massage therapy may provide short-term relief for neck and shoulder pain, arthritic knee pain, reduced fibromyalgia symptoms if therapy is long term, reduced anxiety and depression in people living with HIV, and weight gain in premature babies.
As always, it's crucial to consult with your healthcare provider and insurance company to understand the specifics of your coverage and the potential benefits of massage therapy for your individual health needs.
- When considering alternative treatments like massage therapy under Medicare, it's important to note that Original Medicare, comprising Part A and Part B, does not cover massage therapy as a standalone service, making individuals enrolled in Original Medicare responsible for 100% of the treatment costs.
- On the other hand, the landscape changes with Medicare Advantage (Part C) plans, which may cover massage therapy under specific conditions, such as Aetna Medicare Advantage plans that cover massage therapy when it is part of a physician-prescribed treatment plan and provided by an approved provider.
- Other health organizations like SCAN Health Plan offer a routine therapeutic massage benefit through American Specialty Health (ASH) for most of its plans, allowing self-referral without a doctor’s prescription but requiring initial evaluation and approval through their provider network.
- It's also worth mentioning that Medicare Advantage is not the only option for those seeking massage therapy coverage; Medicaid, a program that helps pay many out-of-pocket healthcare costs, may cover massage therapy costs, including the Qualified Medicare Beneficiary (QMB) program and Extra Help, a program that assists with drug costs under Medicare Part D.
- Preliminary science suggests that massage therapy may provide short-term relief for various health conditions, such as neck and shoulder pain, arthritic knee pain, reduced fibromyalgia symptoms, reduced anxiety and depression in people living with HIV, and weight gain in premature babies, but it's essential to consult with your healthcare provider and insurance company to understand the specifics of your coverage and the potential benefits for your individual health needs.
