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Medicare slow to respond to seniors’ increasing interest in alternative medicine

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People are not only living longer, but according to recent research from Duke University, they’re also living better. Today’s seniors are increasingly healthier in mind and body as they age than ever before. They’re also putting off retirement and working later. Over the last 20 years the percentage of Americans working in their 70s has risen from less than 10 to 15 percent.

As people live longer and continue to be active, they increasingly rely on healthcare professionals not just to heal them when they are sick, but to also provide services that enable them to live full, active lives. As a result, more are exploring alternative therapies as preventive medicine and to alleviate 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+ use alternative medicine – an increase from the 53 percent reported in a 2014 study. Despite a rise in interest, Medicare has evolved little in the way of offering alternative medicine benefits.

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

The National Center for Complementary and Alternative Medicine (NCCAM) has divided the field into four general approaches: biologically-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 can include approaches like Reiki or therapeutic touch. Many of these specific techniques are used by what NCCAM calls whole medical systems such as traditional Chinese, homeopathic, and naturopathic medicines.

Older adults tend to be more prone to encounter problems from standard medical treatment, suffering more from side effects and complications. Alternative medicine therapies like these are usually less invasive than conventional medicine and have fewer side effects making them more and more popular amongst seniors.

Medicare and Alternative Medicine
As of 2020, over 62 million US citizens (nearly 19 percent of the population) rely on some form of Medicare to help cover their healthcare needs. The primary rule of Original Medicare (government-funded Parts A & B) is that if a treatment or service is medically necessary it is covered; however, very few alternative medicine services meet this requirement by Medicare’s standards.

For example, Chiropractic care is one of the most commonly requested alternative medicine services amongst our Medicare insurance clients. However, while Original Medicare Part B does pay for manual manipulation of the spine when deemed medically necessary to correct a subluxation, it does not cover other services or tests a chiropractor might order, such as acupuncture, massage therapy or X-rays.

Massage therapy, another widely requested service, has been shown to ease joint and muscle pain and can reduce the increased levels of stress that tend to come with aging. However, Medicare categorizes massage therapy as an “alternative treatment” not deemed medically necessary, and so it is not covered by Original Medicare Parts A and B.

Acupuncture has been show to also ease chronic conditions such as low-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 fight the opioid use epidemic. As such, Original Medicare now covers acupuncture to treat medically-diagnosed chronic lower back pain.

According to Medicare, chronic lower back pain is described as pain lasting at least 12 weeks and caused by a non-identifiable condition or disease. If qualified, you can receive up to 12 sessions within a 3-month window. After that, if you show improvement, Medicare may cover an additional 8 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 coverage level as Parts A & B, so they will always provide the same alternative medicine benefits offered by the Original Medicare program.

Oftentimes, plans will also provide additional benefits. Most commonly, these include things like dental, vision, hearing or prescription drug coverage, but we’re seeing more plans begin to offer coverage of some alternative medicine services like chiropractic care, massage therapy and acupuncture.  As with Original Medicare, these benefits are usually 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 illness. In these cases, policyholders are generally required to first obtain an order or prescription from an in-network doctor to treat the covered medical condition.

Room for Improvement Calls for Close Examination
There are currently 1.4 million Americans living in nursing homes at an average cost of $48,000 per year. Meanwhile, every day, 10,000 members of the Baby Boom Generation celebrate their 65th birthday (the age at which one becomes Medicare eligible.) While the insurance industry, and especially the Medicare program, continues to expand benefits there remains a lot of opportunity for improvement surrounding alternative medicine coverage.

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

While insurance companies and Medicare work to keep up with increasing interest in these types of treatments, it’s important for adults 65+ to carefully examine any health insurance program they’re putting their money into. Close examination will help ensure they receive the coverage they need not just to get well, but to stay well.

Photo: photovs, Getty Images

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