Medicare Part C (Medicare Advantage) offers coverage for massage therapy, depending on certain conditions. However, Original Medicare does not cover massage therapy.
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 and the associated costs. Lastly, it describes programs that may help with alternative therapy costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Massage therapy involves manipulating the soft tissues of the body. It aims to help manage certain health conditions or foster wellness. This technique is an alternative treatment that people from various cultures have used for centuries.
Therapists use many different massage techniques, with Swedish or classical massage being the most common in Western countries, according to the
Few scientific studies investigate the possible benefits of massage therapy. However, the NCCIH notes 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
- weight gain in premature babies
The NCCIH also states that massage therapy has few risks, noting that there are rare reports of serious side effects, such as bone fractures or nerve injuries.
Medicare is the federal health insurance program for people ages 65 years and older, along with younger individuals with certain disabilities.
There are four main parts to the program:
- Original Medicare, which includes Part A and Part B
- Part C, known as Medicare Advantage
- Part D, which provides coverage for prescription drugs
Original Medicare
Original Medicare comprises Part A, which covers hospitalization insurance, and Part B, which deals with outpatient services. Part A includes coverage for hospital and nursing home stays, hospice, and some home healthcare. Part B includes outpatient care, such as doctor visits, lab tests, and medical equipment.
Medicare Advantage
Medicare Advantage, or Part C, is the alternative to Original Medicare and provides the same coverage as parts A and B, with some plans offering additional benefits. Most Advantage plans include prescription drug coverage with other additions, such as dental, vision, and hearing care.
Part D
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.
Medigap
Private insurance companies offer Medicare supplemental insurance (Medigap), which pays 50 to 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.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Coverage for massage therapy differs between Original Medicare and Medicare Advantage.
Original Medicare
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.
Medicare Advantage
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 for coverage, the massage treatment must meet these two conditions:
- a state-licensed massage therapist provides the service
- a healthcare 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. Here, we describe the differences between the two programs regarding therapy treatment and coverage.
Original Medicare
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.
Acupuncture
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.
Chiropractic
Medicare Part B covers chiropractic care to correct a vertebral subluxation, which is when the spinal joints do not move properly, but the contact between them remains intact.
A person who has this treatment pays 20% of the cost after meeting the Part B deductible of $240.
Medicare Advantage
Advantage plans offer all the benefits of Original Medicare, covering physical, occupational, and speech therapy. The program also includes acupuncture and chiropractic services, which this article outlines earlier.
However, Advantage plans with acupuncture or chiropractic benefits offer more extensive coverage than Original Medicare. The costs vary among plans.
People with low incomes and limited resources may get help with alternative therapy costs from the Qualified Medicare Beneficiary (QMB), Extra Help, or Medicaid.
QMB
The QMB program is one of four state-run programs that aim to help those with limited incomes 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
- copays
- coinsurance
- deductibles
The QMB program also helps with prescription costs by limiting how much a drugstore can charge for a prescription. In 2024, the limit is $11.20 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
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 alongside 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.