Is Acupuncture a Covered Benefit? Know Your Benefits

Many people are surprised to find out that their Covered California health plan includes coverage for acupuncture.  Under the Affordable Care Act, each state selected a benchmark plan and all the benefits included in the benchmark plan are considered “essential health benefits”.   Essential benefits vary from state to state, however cannot include annual and/or lifetime dollar maximums.

In California, acupuncture  is an essential benefit and must be covered by individual health plans to comply with federal and state law.  This means that your health plan cannot deny you treatment for acupuncture care as long as it is for treatment of nausea or as part of a comprehensive pain management program.   As long as you can show that acupuncture is medically necessary for your condition, there are no annual limits on the number of visits you can receive.  You should only pay your standard primary care visit co-pay when you seek care, for example $45 on a Silver plan.

AUTHOR - Ali Nagy