Does My Insurance Cover Acupuncture?

 

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It’s a question I hear all the time and most people assume they don’t have coverage for acupuncture. Actually a significant number of people do have some benefit. In Hawaii acupuncture coverage is not a part of the Essential Health Benefits, the mandatory set of health benefits each insurance plan needs to provide under the Affordable Care Act, yet. It is part of the Essential Health Benefits in California, Alaska, New Mexico, Maryland and Washington. So, hopefully, it’s just a matter of time![1]

Until then quite a few insurance plans have chosen to cover acupuncture just because it’s awesome. Remember that these benefits renew annually so now is a good time to take advantage of your plan!  Here’s the breakdown:

 

Insurance Company Benefit Copay Important to know
HMSA and Kaiser Between 12-20 visits per calendar year*^ $10-20 ^Most plans do not have any coverage including those for HSTA, Quest, and HGEA. For those that do, this acupuncture benefit is provided through ASH Networks.
UHA $500 benefit per calendar year*^ $10 ^Combined benefit between acupuncture and chiropractic
HMAA 20 visits per year*^ $7-15 ^All plans provide coverage except the Comprehensive Basic
HMA, Family Health Hawaii Varies Varies
Worker’s Compensation Referral from Primary Care Provider (PCP) needed for approval from the insurance adjuster. Usually 10-15 visits per treatment plan none Can continue with more referrals
Auto PIP Optional complimentary care benefit of 30 visits shared between acupuncture and chiropractic None Make sure you have selected the Alternative Care option for this benefit.

 

*Always call your insurance company to verify the specifics of your coverage. Coverage is generally for musculoskeletal pain conditions only.

Some out-of state companies like Blue Cross Blue Shield and Cigna may offer coverage but finding an in-network provider in Hawaii may be difficult. Keep in mind acupuncture may also be used as a medical expense in a Flex spending account, but not herbal medicine.

Here are some local companies/unions that offer their employees an acupuncture benefit:

Hawaiian Airlines

Oceanic Time Warner Cable

Hawaii Electrician’s Health and Welfare Fund

CVS Caremark

AFL Hotel & Restaurant Workers Health and Welfare Trust Fund

Hawaii Teamsters Health & Welfare trust Fund PPO plan

Hawaii Teamsters Health & Welfare trust Fund HMO plan (yellow card Member ID cards)

UFCW – Hawaii Food Employers Health & Welfare Trust Fund

Times Supermarket

ILWU Local Health & Welfare Trust Fund (HOTEL)

ILWU Local Health & Welfare Trust Fund GENERAL (light Blue Member ID cards)

Island Air

Insurance coverage for acupuncture in Hawaii is increasing, albeit slowly. Don’t wait for your carrier to offer coverage before getting acupuncture. Most acupuncturists charge between $50-100 per treatment and many offer discounted package rates, senior rates or sliding scale. Remember that acupuncture stimulates your body to heal itself and it’s always a good idea to invest in your health!

[1] http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf416179

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