How to Shop for Health Insurance with Acupuncture: Advice from a Portland Acupuncturist

Welcome to the To The Point PDX Acupuncture’s 2nd annual of How To Shop For Health Insurance, 2019 edition.

It’s open enrollment time! It’s the time of year that you can choose whatever health plan you want. Here’s a handy guide to make this overwhelming process a bit easier.

If you’re a full-time employee of a company:

If you’re employed and your company offers health insurance, it’s our recommendation that you go to your Open Enrollment meeting offered by your HR department – and ask what plan gets you the best acupuncture coverage. (And if your employer doesn’t offer a plan that covers acupuncture – tell your HR department this is a benefit you would like to see next year!)

As an employee, you often can choose the tier of your healthcare plan.  You often have the chance to choose your carrier, your premium, your deductible and sometimes you get the chance to choose alternative healthcare coverage! Unless you have a “life-changing” event – like marriage or having a baby – you only get once chance a year to lock in your health insurance plan. Be educated the choose wisely.

If you’re self employed or shopping for health insurance on Healthcare.gov

You’re in luck - we’ve sorted through all of the plans offered on the Healthcare.gov exchange for Oregon and found a few plans do offer acupuncture coverage.

Some Moda Health Plan – like the Moda Health Cornerstone Sliver 3000, Moda Health Beacon Gold 1000 and Moda Health Beacon Silver 3000 will allow you to see a Portland acupuncturist for a copay ranging from $15-$35. You can get about 10-15 visit a year with the $1,000 benefit max offered by these plans. However, these are some of the most expensive plans on the exchange! These Moda Health plans range from $430 to $441 a month – that’s over $5,000 a year in just healthcare premiums - not including any deductibles or copays you may be responsible for.

The Kaiser Permanente - LP OR Bronze 6550/0% HSA plan is a bit more affordable, costing you $286/month. The plan covers 12 acupuncture visits a year, but you need a doctor’s note for the coverage to take effect. Also, the Kaiser plans only allow you to see certain acupuncturists – and you can’t use this plan to see the Portland acupuncturists at To The Point PDX.

The Pacific Source: Legacy Bronze HSA 6650 could be a good choice; this plan offers a $1,000 max benefit coverage - getting you about 10-15 visits a year.

And finally, two Providence Health Plans – the Connect 7900 Bronze and the Connect 2500 Silver say they offer acupuncture coverage – but you’ll only get 3 visits a year.

What gives? It says Sarah Hammer, LAc is a covered provider for many more plans… but acupuncture is excluded!

In 2019 you can filter your plan search based on a provider – but this can be very confusing if you’re looking for acupuncture coverage. One of the provisions of the Affordable Care Act says that a group health plan may not discriminate against “any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”  So yes, Sarah Hammer, LAc and Tara Grant, LAc do work within the scope of the provider’s license or certification so yes, technically they are covered providers. However, there is no law that says that acupuncture needs to be covered. It’s the health insurance’s sneaky way of adhering to the guidelines of the ACA without having to fork over the money to cover your acupuncture visit.

So, what should I do?

Here’s our pro tip: Don’t spend your money on any of these plans if you are looking for only for acupuncture benefits – you’re better off using the “prompt-pay” rates of the Portland acupuncturist you want to see. Ask your practitioners for details. If you plan on going to the acupuncturist twice a week and are otherwise healthy, do not spend more than $364 a month on health insurance to get acupuncture coverage. Plus, many of the plans listed above have a deductible to reach before the acupuncture coverage kicks in; meaning you need to spend at least $1,000 out of pocket expense before insurance will even begin to think about covering your visits. There might be a plan that has a lower premium that fits your needs. Paying the ‘prompt-pay’ rate for your acupuncture visits may save you money in the long run.

Bottom line: If you’re healthy, do not suffer from any chronic illnesses, and want to be sure you have all the money you need to see the acupuncturist as needed, check into high deductible health savings account plans. A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (translation: high out-of-pocket deductible, but lower monthly cost). The funds contributed to an account are not subject to federal income tax at the time of deposit. HSA and FSA (Flex Spending Account) dollars can be used for acupuncture in Portland at To The Point PDX.  

And be sure to use your healthcare benefits for 2018!

If you currently have acupuncture benefits for 2018 – be sure to use them!! Many employee plans offer $1,500 (or more!) of integrative healthcare benefits a year. If you don’t use these benefits, you LOSE THEM. Even if your current plan only includes 3 covered visits, be sure to use them. Give us a call to verify you benefits. Don’t let the insurance company win. Get yourself some acupuncture today!  

And lastly…

WHO NAMED THESE HEALTH INSURANCE PLANS? As if health insurance wasn’t confusing enough, the names of the healthcare plans on Healthcare.gov are enough to drive anyone crazy. The names make zero sense. Our advise: create a spreadsheet and list advantages of each plan and pay extra special attention to the name of the plan you choose.

Disclosure: We're not qualified to counsel you on the best healthcare coverage for your or your family - we can only share what we know. Please talk to a benefits specialist to see what is right for you and your family. Thinking of an HSA plan? Talk to your accountant/tax advisor first.