The American Massage Therapy Association (AMTA) has been working on getting massage therapy covered by Medicare Advantage Plans since 2018.
August 2018 – AMTA began an outreach effort with approximately 700 Medicare Advantage insurance companies encouraging them to follow the Center for Medicare Services recommendations by covering medically-approved massage therapy provided by state licensed massage therapists. While coverage of massage therapy is not automatic, AMTA is asking Medicare Advantage plans to consider it for 2019 and 2020. AMTA Website
Yesterday I attended the webinar they put on called Medicare Advantage 101 led by ATI Advisory and AMTA’s National Government Relations team. ATI Advisory is a firm dedicated to helping public and private healthcare leaders solve complex healthcare challenges through objective research, deep expertise, and practical solutions.
Presenters:
- Tyler Cromer, Principal, ATI Advisory
- Joseph June, Analyst, ATI Advisory
- James Specker, Senior Director, Government and Industry Relations, AMTA
- Martha Rinker, Government Relations Policy and Research Analyst, AMTA
- Deborah Outlaw, Federal Lobbyist, The Outlaw Group
Medicare Advantage 101
Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare offered through private insurance companies that contract with Medicare. These plans provide all the benefits of Original Medicare (Parts A and B), often include additional services like vision, dental, and hearing, and sometimes cover prescription drugs (similar to Medicare Part D). Medicare Advantage plans typically bundle these services into a single plan, allowing beneficiaries to receive all their healthcare needs in one place.
In Original Medicare, beneficiaries can see any doctor who accepts Medicare. In contrast, most Medicare Advantage plans have provider networks, which may limit choice or require higher costs for out-of-network providers. Medicare Advantage also sets an annual cap on out-of-pocket expenses for Part A and Part B services, which Original Medicare lacks, providing financial protection if extensive care is needed.
Pros and Cons
Pros:
- Potentially lower premiums (some plans have $0 premiums)
- Extra benefits like vision, hearing, dental, and wellness programs
- Out-of-pocket maximum for Part A and B services, providing a safety net
Cons:
- Restricted provider networks (may not cover all doctors and hospitals)
- Coverage and costs can vary widely, making it essential to review plans carefully each year
- Plans can require prior authorization for certain services, adding a layer of approval before receiving care
Just so you know…Medicare Advantage’s popularity suggests that many beneficiaries appreciate the added benefits and simplicity of a single plan. However, critics argue that expanding the role of private insurers within Medicare represents a movement toward privatizing what has historically been a public program. They warn that the shift could undermine the long-term sustainability and universality of Medicare, possibly increasing costs and reducing care options for beneficiaries in the future.
The debate around Medicare Advantage is essentially about the future direction of Medicare: should it remain primarily a public program, or should it evolve into a hybrid model that leans increasingly on private insurers? The growth of Medicare Advantage points toward the latter, reflecting a broader shift toward privatization in American healthcare policy.
Massage Insurance Billing 101
First you might want to check to see what plans are covering massage therapy in you area. AMTA said they would be providing the list, but you can also start checking in your local Facebook Groups for Information or join my Facebook Massage Insurance Billing Group.
Some carriers will require that you become a credentialed provider with them. Each of them has their own system for doing that, so you will need to get that information from them directly. Some carriers will allow you to bill and get paid without being credentialed.
What you will need:
- An NPI number. Online: Go to https://nppes.cms.hhs.gov/ ,
click on “Apply Online,” and follow the steps. Most of the registration process is straightforward. When you get to “Taxonomy,” select “22: Respiratory, Rehabilitative & Restorative Service Provider,” then scroll down to “Massage Therapist.”Contact the NPI Enumerator program via any of the following methods:
Phone: 800-465-3203
TTY: 800-692-2326
Email: customerservice@npienumerator.com
Mail: NPI Enumerator, PO Box 6059, Fargo, ND 58108-6059 - You will need to be HIPPA Compliant. See my book my book the Massage Insurance Billing Manual (to purchase PDF) or Paperback/Kindle on Amazon.
- You will need to know how some of the laws around billing and working with insurance regarding fraud and fee setting. You will need to learn how to fill out a billing form using specific billing codes, how to set your fees, Learn the Basics of Billing with my book the Massage Insurance Billing Manual (to purchase PDF) or Paperback/Kindle on Amazon.
Challenges in Working with Insurance
In WA State we have been able to bill Health Insurance Plans since about 1996, when the insurance commissioner at that time (Deborah Senn) created a law that mandated coverage of massage therapy here. It was fought by the insurance companies but Senn won. (You can see the history of this important legislation here)
Over the many years we have been faced with dwindling allowable fees, decreasing benefits and network adequacy issues. The low fees are always the main problem and may be a challenge when billing these Medicare Advantage Plans. You will have to weigh out the pros and cons of billing insurance. I can tell you that it won’t always be easy: more paperwork (charting, billing, following up, appeals etc), but on the other hand massage therapy is getting to be more accepted as a viable part of healthcare.
There is also power in numbers. The more massage therapists we have billing and understanding the process as well as clients receiving massage under these benefits, the more people we will have when it comes time to advocate for the massage profession and work for fair pay from insurance carriers.