Alternative medicine

Medicare slow to respond to growing interest of older adults in alternative medicine

Not only are people living longer, but according to recent research from Duke University, they are also living better. Today’s older people are increasingly healthier in mind and body as they age more than ever. They are also postponing their retirement and working later. Over the past 20 years, the percentage of working Americans in their 60s increased less than 10 to 15 percent.

As people live longer and continue to be active, they rely more and more on health care professionals, not only to care for them when they are sick, but also to provide them with services that allow them to live a full and active life. As a result, more and more people are exploring alternative therapies as preventative medicine and to relieve symptoms such as chronic pain and arthritis. In fact, according to a recent study conducted at Ohio State University, about 70 percent of those 50 and over are using alternative medicine – an increase from the 53 percent reported in a 2014 study. Despite renewed interest, Medicare has changed little in the way it offers alternative medicine benefits.

What is Alternative Medicine?
Alternative medicine is an umbrella term for medical practices or theories that fall outside of generally accepted traditional Western medicine. When used with traditional medicine, alternative medicine is sometimes called complementary medicine.

The National Center for Complementary and Alternative Medicine (NCCAM) has divided the field into four general approaches: biology-based practices such as herbs or supplements, mind-body medicine approaches such as meditation or music therapy, body-based practices such as massage, chiropractic or acupuncture, and energy medicine, which may include approaches such as Reiki or therapeutic touch. Many of these specific techniques are used by what NCCAM calls comprehensive medical systems such as traditional Chinese, homeopathic, and naturopathic medicines.

Older people tend to be more inclined encounter standard medical treatment problems, suffering more side effects and complications. Alternative medicine therapies like these are generally less invasive than conventional medicine and have fewer side effects, making them increasingly popular among older adults.

Health insurance and alternative medicine
From 2020, more than 62 million US citizens (nearly 19% of the population) depend on some form of health insurance to cover their health care needs. The main rule of the original Medicare (parts A and B funded by the government) is that if a treatment or service is medically necessary, it is covered; however, very few alternative medicine services meet this requirement by Medicare standards.

For example, chiropractic care is one of the most requested alternative medicine services by our Medicare clients. However, while Original Medicare Part B does not cover manual manipulations of the spine when deemed medically necessary to correct a subluxation, nor does it cover other services or tests that a chiropractor might order, such as acupuncture, massage therapy, or X-rays.

Massage therapy, another highly requested service, was shown to relieve joint and muscle pain and can reduce the increased levels of stress that tend to accompany aging. However, Medicare classifies massage therapy as an “alternative treatment” not deemed medically necessary, and is therefore not covered by Original Medicare Parts A and B.

Acupuncture has also been shown to relieve chronic conditions such as lower back, neck and osteoarthritis pain. On January 21, 2020, the Centers for Medicare and Medicaid Services passed the decision to cover acupuncture in certain circumstances as an alternative method of pain management in an effort to help combat opioid use epidemic. As such, Original Medicare now covers acupuncture to treat medically diagnosed chronic lower back pain.

According to Medicare, chronic low back pain is described as pain that lasts at least 12 weeks and is caused by an unidentifiable condition or disease. If you qualify, you can receive up to 12 sessions in a 3 month window. After that, if you show improvement, Medicare may cover 8 more sessions.

Medicare Advantage and Alternative Medicine
Medicare Advantage is a type of Medicare health plan offered by private insurance companies. Medicare Advantage plans are required by the government to provide the same level of coverage as Parts A and B, so they will still provide the same alternative medicine benefits offered by the Original Medicare program.

Often the plans will also provide additional benefits. Most often these are dental, vision, hearing or prescription drug coverage, but we are seeing more and more plans beginning to offer coverage for certain alternative medicine services like chiropractic care, massage therapy and acupuncture. As with Original Medicare, these benefits are generally limited to medically necessary situations. For example, some Medicare Advantage plans will cover massage therapy, but only if the therapy is related to a specific injury or disease. In these cases, insureds are generally required to first obtain a prescription or prescription from an in-network physician to treat the covered medical condition.

Room for improvement requires careful consideration
There is currently 1.4 million Americans living in nursing homes at an average cost of $48,000 per year. Meanwhile, every day 10,000 baby boomers turn 65and birthday (the age at which one becomes eligible for Medicare.) As the insurance industry, and in particular the Medicare program, continues to expand benefits, there are still many opportunities for improvement regarding coverage for alternative medicine.

Taking advantage of these opportunities will help ensure that aging adults have the ability to receive not only treatment, but also preventative measures that will help them stay healthy and out of nursing homes longer, allowing insurers to save money in the long run.

As insurance companies and Medicare scramble to meet growing interest in these types of treatments, it’s important that adults 65 and older carefully consider any health insurance program they invest in. Careful consideration will help ensure they receive the coverage they need to not only recover, but also to stay healthy.

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