ResearchLetter | ComplementaryandAlternativeMedicine Trends in Insurance Coverage for Acupuncture, 2010-2019

This survey study examines US trends in insurance coverage for acupuncture from 2010 through 2019.


Introduction
Acupuncture is recommended as part of comprehensive pain care for low back pain, neck pain, and fibromyalgia by agencies including the Agency for Healthcare Research and Quality. 1 Additional evidence indicates that complementary and alternative medicine, including acupuncture, is associated with reductions in total health care spending among patients with chronic back pain. 2 Research suggests that insurance coverage for acupuncture is inconsistent, although there is a lack of published data concerning coverage in most states. 3One survey of 45 commercial, Medicaid, and Medicare Advantage (ie, Part C) health plans found that only one-third of plans covered acupuncture, suggesting most patients pay for acupuncture entirely out of pocket. 4When insurers covered acupuncture, cost sharing was higher than other nonpharmacological interventions, and insurers tended to cover few indications and clinician types. 3,4re, we document trends in insurance coverage for acupuncturist visits using a nationally representative survey.Given Medicare Part B's 2020 decision to reimburse acupuncture for low back pain, we hypothesized that insurance coverage increased over time. 3

Methods
We examined insurance coverage for acupuncturist visits between 2010 and 2019 using the Medical Expenditure Panel Survey (MEPS). 5The MEPS data are publicly available and are collected using sampling methods consistent with the American Association for Public Opinion Research (AAPOR) reporting guideline.Respondents provided verbal consent to participate in the MEPS.Acupuncture use and demographic characteristics, including race and ethnicity, were self-reported.If not ascertained in the MEPS or National Health Interview Survey, race and ethnicity were assigned based on the respondent's relationship to other household members.Race and ethnicity categories included Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, and non-Hispanic other race or multiple races.This survey study was considered exempt by the Institutional Review Board at the University of Pennsylvania, Philadelphia.
We measured the share of respondents 18 years or older with at least 1 acupuncturist visit.
Among acupuncture users, we calculated the (1) total annual amount paid for acupuncturist visits, (2)   annual amount paid out of pocket for acupuncturist visits, (3) share of acupuncturist visits with any insurance coverage, and (4) percentage paid out of pocket for acupuncturist visits.We calculated the outcomes in 2-year intervals to improve precision and compared outcomes in 2010-2011 vs 2018-2019.Statistical significance was defined as a CI excluding 0. Analyses were performed in Stata, version 17.0 (StataCorp LLC).

Results
The overall full-year file MEPS response rate varied from 39.5% in 2019 to 56.3% in 2012 during the study period.(

Figure .
Figure.Trends in Office Visits With Acupuncturists in the Medical Expenditure Panel Survey, 2010-2019 250 An accessible table with the original number of surveys distributed is not available given the National Health Interview Survey and MEPS logistics.)Theproportion of respondents with at lease 1 acupuncturist visit increased from 0.4% in 2010 to 0.8% in 2019(Figure).Of the 1344 Author affiliations and article information are listed at the end of this article.This is an open access article distributed under the terms of the CC-BY License.

Table .
Trends in Spending and Insurance Coverage for Acupuncturist Visits in the Medical Expenditure Panel Survey, 2010-2019 a