Original Medicare does not cover massage therapy, but an increasing number of Medicare Advantage plans — known as Part C — offer coverage, depending on certain conditions.
A person enrolled in an Advantage plan that includes massage therapy will get treatment coverage under certain conditions. To qualify, a doctor must order the massage therapy to treat a specific health condition, while a state-licensed therapist must administer the treatment.
This article explores the technique of massage therapy. Next, it provides an overview of Medicare, examining what parts of the program cover the treatment. Then, it looks at other therapies Medicare covers, as well as the associated costs. Lastly, it describes programs that may help with alternative therapy costs.
Massage therapy is the manipulation of the soft tissues of the body. It aims to help manage certain health conditions or foster wellness. The technique is an alternative treatment used by various cultures for centuries.
Therapists use many different massage techniques, with Swedish or classical massage being the most common in Western countries, according to the National Center for Complementary and Integrative Health (NCCIH).
There are few scientific studies investigating the possible benefits of massage therapy. However, the NCCIH note that preliminary research suggests the treatment may promote:
- short-term relief of neck and shoulder pain, as well as arthritic knee pain
- reduced fibromyalgia symptoms if the therapy is long-term
- reduced anxiety and depression in people living with HIV or AIDS
- weight gain in premature babies
The NCCIH also state that massage therapy has few risks, noting that there are rare reports of serious side effects, such as bone fractures or nerve injuries.
There are four parts to the program:
- original Medicare, also known as Part A and Part B
- Part C, known as Medicare Advantage
- Part D, which provides coverage for prescription drugs
Original Medicare comprises Part A, which covers hospitalization insurance, and Part B, which deals with medical insurance. Part A includes coverage for hospital and nursing home stays, hospice, and some home healthcare, while Part B includes outpatient care, such as doctor visits, lab tests, and medical equipment.
Medicare Advantage, or Part C, is the alternative to original Medicare and provides the same coverage as Parts A and B, with additional benefits. Most Advantage plans include prescription drug coverage with other additions, such as dental, vision, and hearing care.
Part D is prescription drug coverage available with original Medicare. Each plan supplies a list of covered drugs and generally provides at least two medications in each commonly prescribed class.
Private insurance companies offer Medicare supplemental insurance, which pays 50–100% of Parts A and B out-of-pocket costs, such as coinsurance, copays, and deductibles.
If a person has Medicare Advantage, they cannot also have a Medigap plan.
Coverage for massage therapy differs between original Medicare and Medicare Advantage, as detailed below.
Original Medicare does not cover massage therapy, so a person must pay 100% of treatment costs. Because massage therapy falls under the category of alternative medicine, Medicare does not consider it medically necessary.
Some Medicare Advantage plans may cover alternative medicine treatments, including massage therapy, if they are considered primarily health-related, according to the Centers for Medicare & Medicaid Services.
To qualify, the massage treatment must meet these two conditions:
- a state-licensed massage therapist provides the service
- a doctor or health professional orders the massage therapy for a specific health purpose, rather than for relaxation
Costs for massage therapy sessions for Advantage plan enrollees may involve copays, coinsurance, or deductibles. These costs vary among the different plans.
Original Medicare and Medicare Advantage cover therapies other than massage, although Advantage plans provide broader coverage of alternative treatments. Below is a description of the differences between the two programs regarding therapy treatment and coverage.
Original Medicare covers physical, occupational, and speech therapy. In addition, under certain circumstances, it covers acupuncture and chiropractic treatment, both of which are alternative treatments.
Medicare Part B covers acupuncture for chronic low back pain only. To receive this diagnosis, a person must meet the following requirements:
- the pain is not due to surgery or pregnancy
- the pain has no known cause
- the pain persists for at least 12 weeks
A person with chronic low back pain may obtain coverage of up to 12 acupuncture visits within 90 days. If a person shows improvement with this treatment, Medicare covers an additional eight appointments, for a maximum of 20 treatments per year.
Medicare Part B covers chiropractic care to help a person manage active back pain, as opposed to coverage for preventive or maintenance treatment. This means Medicare will only fund chiropractic care to correct an existing problem.
Advantage plans offer all the benefits of original Medicare, providing coverage of physical, occupational, and speech therapy. The program also includes acupuncture and chiropractic services as described above.
However, Advantage plans with acupuncture or chiropractic benefits offer more extensive coverage than original Medicare. The costs vary among plans.
The QMB program is one of four state-run programs designed to help a person with limited income meet their Medicare costs. People who enroll with QMB are also enrolled with Medicaid.
The QMB program pays for:
- Part A monthly premiums
- Part B monthly premiums
The QMB program also helps with prescription costs by limiting how much a drugstore can charge for a prescription. In 2021, the limit is $3.90 for a prescription medication covered under Medicare Part D.
A person who qualifies for enrollment in the QMB program has automatic enrollment in Extra Help, which also covers some costs of a Medicare Part D plan. However, it does not help with therapy treatment costs.
Medicaid helps pay many out-of-pocket healthcare costs for either original Medicare or Medicare Advantage. Since it can work with Medicare Advantage, it may help pay a plan’s massage therapy costs, in addition to other alternative treatment costs.
However, not all providers accept Medicaid. In these cases, a person can check with a federally qualified health center to enquire about further help with costs.
Massage therapy is an alternative treatment that may offer health benefits. Studies suggest it may reduce certain types of pain, relieve fibromyalgia symptoms, and lower anxiety in people with AIDS.
Some Advantage plans offer massage therapy as a plan benefit, although out-of-pocket costs, such as copays or coinsurance, vary among plans. A person who needs help in paying the costs may qualify for Medicaid.