Acupuncture as an Essential Health Benefit

Since the Patient Protection and Affordable Care Act (Obamacare) was implemented, people have become more aware of what different health insurance plans include, since those who used to have only one option, or none at all, now have more choices. Acupuncture enthusiasts were pleased to learn that as part of the Affordable Care Act, some states, including California, opted to include acupuncture as an essential health benefit.


Acupuncture as an Essential Health Benefit

What is an Essential Health Benefit?

An Essential Health Benefit is one of a government-mandated set of benefits that health insurance plans must cover in order to be sold as health insurance in the United States. These include basic services you’d expect your health insurance to cover, such as hospitalization, emergency services, and prescription drugs. However, they also include some additional services that health insurance companies did not always cover in the past, such as maternity care and services related to substance use. This means that patients who used to have to pay out of pocket for these services could now use their health insurance plans.

California in 2014

In 2012, the state of California signed a statewide bill to include acupuncture as an essential health benefit. It went into effect in 2014, under the Patient Protection and Affordable Care Act (PPACA). Other states began to look at their own state-specific healthcare systems and legislation in response, and some chose to cover acupuncture as well.

Covered by Insurance

As an essential health benefit, insurance companies in the state of California and others that passed this legislation must cover acupuncture treatment services for patients. This not only makes acupuncture services more accessible and affordable, it helps to legitimize acupuncture as a treatment option for patients who may not have tried it.

Small Co-Pay

In general, medically-necessary acupuncture appointments should only cost patients with health insurance a small co-pay, identical to that paid for other specialized medical services. Depending on your health insurance plan, this is often, though not always, around $30. Acupuncture without a medical prescription may not be covered.

Integrated Approach

The state of California opted to include acupuncture as an essential health benefit to improve patient choice in treatment services and to promote cost effective treatment solutions. This adoption also highlights some of the healthcare industry’s slow transition toward a more integrated approach. Living a healthy lifestyle, which may include acupuncture, can help you feel better overall. It is great to see that more organizations, including the government, now support an integrated treatment approach for a wide range of conditions.

Acupuncture is a highly effective part of an integrated treatment plan for many. Whether you live in California or somewhere else, it’s worth giving it a try. For those located in California, make an appointment at the Thumos Health Center by calling (310) 428-1215 to start your integrated and holistic approach to health care.

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