Advocacy: Overview of Medicare Advantage

 Februrary 1, 2025

Medicare Advantage, also called Medicare Part C, is a private insurance option approved by Medicare that serves as an alternative to original Medicare.

These plans provide all the benefits of Part A (hospital insurance) and Part B (medical insurance) and often include additional coverage for services like vision, dental and wellness programs. Most Medicare Advantage plans also offer prescription drug coverage (Part D).

With a focus on a more holistic approach to healthcare, these plans frequently tailor their benefits to meet the diverse needs of their members, which can include support for pain management and wellness services.

Medicare Advantage plans operate through networks of healthcare providers, and enrollees typically need to follow specific rules regarding where and how they receive care.

Massage Therapy and Medicare Advantage

While original Medicare does not cover massage therapy, some Medicare Advantage plans may offer it as part of their expanded benefits. This coverage is typically included under wellness or complementary therapy options, recognizing the role of massage therapy in managing chronic and acute pain, reducing stress, and improving overall health.

Coverage details, such as the conditions eligible for massage therapy, the number of sessions allowed and reimbursement policies, vary by plan. Massage therapy clients should check with their specific Medicare Advantage provider to understand the scope of their benefits, including any referral or pre-authorization requirements.

Licensed massage therapists interested in working with Medicare Advantage clients must familiarize themselves with billing codes, documentation standards and network participation criteria to ensure compliance and streamline reimbursement processes.

Does Medicare Advantage Cover Massage Therapy? What Should Clients and Therapists Know? 

Yes, Medicare Advantage plans can cover massage therapy under certain conditions. Since 2020, Medicare Advantage plans have been able to offer non-medical benefits that meet members' health and social needs, including therapeutic massage. For 2025, over 250 Medicare Advantage plans nationwide are offering the therapeutic massage benefit.

Coverage details vary by plan and may include limitations on eligible conditions, the number of sessions allowed and reimbursement rules. Clients should contact their specific Medicare Advantage provider for details on coverage, referral requirements and pre-authorization processes.

Licensed massage therapists should understand the billing codes, documentation standards and network participation requirements to ensure compliance when working with these plans.

How Can Massage Therapists Participate in Medicare Advantage Networks and Manage Billing for Clients? 

To work with Medicare Advantage clients, licensed or certified massage therapists must:

• Join the network of providers for the specific Medicare Advantage plan.
  
  
• Learn the required billing codes and reimbursement policies for therapeutic massage.
  
  
• Follow documentation standards and pre-authorization procedures required by the plan.

Being proactive in understanding the individual plan’s requirements ensures a smoother process for reimbursement and compliance. By doing so, massage therapists can effectively expand their services to clients covered by Medicare Advantage plans.

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