Is Massage Therapy Covered by Insurance?
Tips to Help Get Health Insurance to Cover a Massage
Although many people think of a massage as something you request at a spa to pamper yourself, massage therapy can have many medical benefits. Massage therapy can relieve muscle tension, improve circulation, help with pain management, help with stress and anxiety, and provide a variety of other health benefits. Massage therapy is considered a part of Complementary and Alternative Medicines (CAM), which can be used to complement standard medical treatment by doctors when addressing certain medical conditions and situations. In the most recent data from the Centers for Disease Control (CDC), 55.2 million adults (23.5%) had at least one expenditure for some kind of complementary health approach.
With so many people turning to massage therapy to help with medical treatments, it would make sense that health insurance should cover massage, but not all policies do so. For example, Medicare does not cover “massage therapy,” so you may be responsible for 100% of the costs, if you seek this treatment. If your health insurance provides coverage, there may be limitations on what is covered by a health insurance plan. Here are the basics you need to know about massage therapy insurance coverage and how to find out if your health insurance covers it.
Do You Have Coverage for Massage?
Massage therapy may be defined in several different ways by an insurance company. How it is defined and the reason for getting the massage will determine whether you will be covered by your insurance. If a “massage therapist” treatment isn’t covered in your policy, be sure and ask about these alternative options and discuss them with your doctor.
If you are eligible for services from osteopaths, chiropractors, occupational therapists, and physical therapists who also use massage techniques, these visits may be covered.
There is no standard requirement for insurance companies to reimburse expenses for massage. Massage therapy may be covered when:
- The massage is considered medically necessary and/or fits the definition and criteria of coverage given by the health insurance company.
- If the massage fits into the criteria of a “habilitative or habilitation” treatment, it may be covered by health insurance as an essential health benefit. You would have to speak with your doctor and your insurance company to be sure.
More health insurance companies are starting to cover massage therapy, so the first thing you need to do to find out if it’s covered in your situation is to ask your insurance company directly.
Getting Insurance to Cover Massage
If you want your health insurance to cover massage therapy, you may have to have your massage therapy prescribed or recommended by a doctor. In a recent survey by the American Massage Therapy Association, 67% of respondents said that their physician recommended they get a massage.
- Before booking a massage, make sure that the provider is accepted by your insurer.
- Find out if the massage must be deemed medically necessary to be covered, and how to meet the criteria. Use the list of questions below to help make sure you get all the information you need.
How Does Coverage for Massage Work?
Once you know that your health insurance covers massage therapy, here are the important questions to ask so you understand how your policy will cover it:
- What are the conditions to qualify for reimbursement?
- Is there is a deductible, or any out-of-pocket cost to you?
- Is there is a maximum amount payable per policy term (year)?
- Is there a maximum reimbursement per visit? For example, if the maximum per visit is $90, and you use a massage therapist who will charge $150, you will not be able to claim the full amount and will have to pay the difference.
- Is there a maximum time limit per body “region” (example, 15 minutes).
- Are there specific massage therapists you must go to?
- Do all types of massage qualify for coverage?
If you and your spouse each have health insurance through an employer, you may be able to claim under both your health insurance plan and your partner’s. You can use coordination of benefits to claim under both policies. In cases where massage therapy would be covered, this would allow you to get the maximum from both plans, which could double your coverage.
With Massage Therapy Coverage Cost
Like all benefits, the more coverage a policy offers, the more it usually costs. The cost will vary by insurer. Taking health insurance through an employer can save you money because the employer will often pay part of the cost of the premium for you, and may also offer health insurance plans with more benefits, like massage therapy. If the massage is considered rehabilitative or is medically necessary, then insurance will not cost you more, as this may fall under the coverage of the Affordable Care Act’s (ACA) 10 essential health benefits.
Therapy Not Covered by Insurance
- If your health insurance does not cover massages, but you have a health savings account (HSA), you may be able to use it to cover massage costs, if your massage qualifies as medically necessary. Learn more about HSAs and flexible spending accounts (FSAs) here.
- Contact local massage schools to see whether they offer massages at a discount.
- Ask for discounts or membership options where you get your massage services.
The Bottom Line
Health insurance may provide coverage for massages that are medically necessary or prescribed by your health management organization (HMO). But even when health insurance covers massage, there may be a limit or maximum amount payable during a policy term.
Before getting a massage, check with your insurance company to determine if it is covered. If not covered as a “massage,” find out if there is coverage for physiotherapy, from chiropractors or other related specialists, and discuss these options with your doctor. If your physician prescribes massage therapy as part of a treatment plan, that may allow you to claim it on your health insurance.