Dealing with pain and fatigue can be difficult for older people, which is why they often turn to therapies and treatments such as massage.
Symptoms of age-related back pain, pulled muscles, and pinched nerves can often be relieved through massage, physical therapy, chiropractic treatments, and acupuncture.
If you’re wondering whether Medicare will cover massage therapy, then read our article to find out what your options are to get these treatments covered.
Massage therapy is the manual manipulation of body tissue and it’s linked with the treatment of pain, heart disease, and stress.
Research has shown that massage therapy can help relieve chronic back pain, fatigue, and general body aches. It is commonly used in sports alongside other treatments to help with injuries and fatigue.
In general, Medicare will not cover massage therapy. This is because massage therapy is classified as an alternative or complementary treatment.
Original Medicare will only cover medically necessary procedures and treatments.
If you are on Original Medicare, we’d recommend that you speak to your doctor about different treatment options and what you’ll be covered for.
Medically necessary is the measure that Medicare uses to define what it will cover. In order for treatment or medical equipment to be medically necessary, the following steps must have taken place:
While people might confuse massage therapy and physical therapy, there are distinct differences between these treatments.
The goal of physical therapy is to relieve symptoms of pain, help people with movement issues, and treat abnormal physical functions caused by injury, disability, or a health condition.
For example, a person that suffers from mild scoliosis (a bend in a person’s spine) can visit a physical therapist who will assist them in regaining proper movement and muscle strength.
On the other hand, a massage therapist can alleviate the symptoms of body pain and discomfort, but they are not trained to identify or treat the sources of these medical conditions.
For example, a massage therapist might be able to relieve pain from scoliosis, but they will not be able to give patients daily exercises or a treatment program to address their underlying medical problem.
If you have a Medicare Advantage Plan, you may be able to get your massage therapy covered.
Medicare Advantage is the new name for Medicare Part C. Medicare Advantage Plans are health care plans offered by private insurance companies for people on Medicare.
There are a number of Medicare Advantage providers contracted into the federal Medicare program by the Centers for Medicare and Medicaid Services.
Depending on the listed benefits of your coverage and your type of plan, a person with a medical need might be able to visit a massage therapist and get their treatment covered.
This is because Medicare Advantage Plans are required by law to offer equivalent cover to Original Medicare.
By law, Medicare Advantage Plans must offer the same benefits as the government-run program in order to be recognized by the Centers for Medicare and Medicaid Services (CMS). This is called equivalent coverage.
Most Medicare Advantage Plans offer their members additional benefits and it isn’t uncommon for people to get coverage for services that Original Medicare doesn’t pay for.
Some common examples of this include cover for:
They also offer members access to perks such as discounts on over-the-counter medication and access to fitness centers across the U.S.
However, your benefits will depend on the plan you have and you’ll have to check with your provider to know if you are covered for massage therapy.
To do this, you can look through your plan’s terms and conditions and see what you’re covered for, or contact your provider and ask them whether they will pay for your massage therapy treatment.
Once you know if your plan covers massage therapy, here’s what you’ll need to do to make sure that they’ll pay for your treatment.
1. Visit your primary care physician. Ask them for a diagnosis and that they recommend massage therapy as a treatment option.
2. Get a massage therapy prescription from your doctor (either in-network or out-of-network).
In-network: This means that a medical practitioner is registered with a health care plan and contracted to perform services to that plan’s members. Typically, if you use an in-network doctor, your plan will cover all of your treatment costs.
Out-of-network: This means that a health care professional is not contracted by your health care plan. People that use out-of-network doctors will usually pay all or some of the costs for their treatment. In some cases, they will have to pay a fixed co-payment.
3. Find a licensed massage therapist in your state who is registered with your PPO or HMO network.
4. Remember that you might still have to pay a deductible, coinsurance, or a co-payment for your massage therapy.
The two most common types of Medicare Advantage Plans have network structures for doctors, health care professionals, and services.
HMOs (Health Maintenance Organizations): These are plans that will cover treatments if they are done by a health care provider who is contracted into their network. They may cover part of the cost of out-of-network services.
PPOs (Preferred Provider Organizations): These plans are less restrictive than HMOs and will generally cover some of the costs if their members visit a health care professional who isn’t on their network.
If you are on an HMO or PPO, it’s important to check whether your health care provider is contracted to your Medicare Advantage Plan (in-network). If they are not, you may not be covered by your Medicare Advantage Plan if you decide to use their services.
If you’d like to find out which PPO and HMO Medicare Advantage Plans have the largest network of health care providers in your area, reach out to one of our agents to get assistance.
Medicare Supplement Insurance won’t cover your massage therapy because it is designed to cover additional costs of Original Medicare.
Medicare Supplement Insurance typically pays for costs such as deductibles, coinsurance, and extended hospital stays, or specific procedures, tests, and items.
Deductibles: These are costs that you will need to pay before Medicare will begin to cover your health care expenses.
Coinsurance: These are the portion of medical costs that a person is responsible for. For Medicare Part A, this is charged on a per-day basis. For Medicare Part B, beneficiaries are usually required to pay 20% of the costs.
Uncovered Costs: Medicare doesn’t cover all medical expenses and there are times when you might have to pay for treatments, services, and tests out of your own pocket.
For example, Medicare doesn’t cover people if they travel to territories outside the U.S. Most Medicare Supplement Insurance Plans offer this added coverage.
If you have Medicare Supplement Insurance, you’ll probably save money on other medical expenses which will free up some cash to pay for alternative treatments like massage therapy.
If you’re wondering what Medicare will cover, there are a few types of treatments you can look at, including:
Physical Therapy: Medicare will cover some physical therapy treatments as long as it is prescribed by a registered medical practitioner.
Chiropractic treatments: Medicare will pay for some forms of chiropractic that are intended to treat lower back pain.
Acupuncture treatments: Medicare will cover acupuncture in very specific circumstances and if it is performed by a licensed acupuncturist in your state.
If you suffer from lower back pain and all other treatment options don’t work, you’ll be able to get up to 20 acupuncture sessions in a calendar year.
Prescription Drugs: If you have Medicare Advantage or a Part D Plan, you may be able to get your prescription drugs for pain and inflammation covered.
If you have Original Medicare, you’ll be covered for 80% of your doctor’s costs but will have to pay for your medication on your own.
Medicare will only cover treatments that are considered medically necessary and which are approved by the Centers for Medicare and Medicaid Services (CMS).
If you’re interested in learning about what Original Medicare, Medicare Advantage Plans, and Medicare Supplement Insurance will cover, check out our Medicare hub.
We have loads of articles that will help you find the right coverage plan for your circumstances, as well as content on costs, enrollments, and the different Medicare Advantage Plans you can get.
We can provide accurate information and assist you with finding Medicare Advantage Plans and providers in your area.