Insurance, HSA/FSA and Coverage for Massage Therapy

Medicare (United States)

Medicare.gov states plainly that Medicare does not cover massage therapy, and that you pay all costs for non-covered services, including massage therapy. [1] It adds that some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover, such as vision, hearing or dental, and tells you to contact the plan for more information. [1] Whether any Advantage plan includes massage is not stated on that page, so ask the plan directly.

Private Insurance (United States)

NCCIH reports a study of national survey data on acupuncture, chiropractic and massage: for people with insurance, coverage of these three approaches was more likely to be partial than full. [2] It also says insurance plans differ greatly in what they cover, and even if a plan covers an approach, restrictions may apply. [3] Proper evidence not found for a current, national statement on how many US plans pay for massage; we read federal and professional-body pages and found none.

Questions NCCIH suggests asking your insurer include:

• Is this approach covered for my health condition? [2]
• Does it need to be preauthorized or preapproved, ordered by a prescription, or need a referral? [2]
• Does coverage require a practitioner in the network, and what if I go out of network? [2]
• Are there limits on the number of visits or the amount I pay? [2]

NCCIH also advises keeping records of every contact with your insurer, including notes on calls and copies of bills, claims and letters. [2] If you want a practitioner to bill your plan, ask them: "Do you accept my insurance plan?" and "Do I file the claims, or do you take care of that?" [2] If you have questions about insurers, NCCIH says your state insurance department may be able to help. [2]

HSA and FSA Accounts (United States)

NCCIH describes two tax-favored accounts that may help cover the cost of some complementary approaches: the flexible spending arrangement (FSA), a benefit offered by some employers, and the health savings account (HSA), for people in high-deductible health plans. [2]

Whether a particular massage counts is a separate question, and we could not answer it from official text:

• The IRS says medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness, and do not include expenses that are merely beneficial to general health. [4]
• IRS Publication 502 defines medical expenses as the costs of diagnosis, cure, mitigation, treatment or prevention of disease. [5] It names fees paid to a chiropractor for medical care as includable, but we did not find massage named in the sources we read. [5]
• An IRS question-and-answer on exercise says that exercise for the improvement of general health is not a medical expense even if a doctor recommended it. [4] That is about exercise, not massage, but it shows that a doctor's recommendation alone was not the test in that example.

In short, Proper evidence not found in the IRS pages we read for a rule that names massage. Plan administrators set their own documentation rules. Ask yours: "Is massage an eligible expense on my plan, and do you need a note from my doctor or other proof of the condition being treated?" We make no claim about what documents a particular plan requires.

Outside the United States

• United Kingdom. The NHS says it may offer some complementary therapies based on evidence of how well they work and whether they are good value for money. [6] The NHS page we read gives acupuncture, Alexander technique lessons and hypnotherapy as examples and does not list massage. [6] We did not read a source on private UK insurance for massage.
• Canada. Proper evidence not found. We could not read the Canada Revenue Agency's medical-expense page or provincial plan rules, so we make no statement about tax credits or coverage.
• Elsewhere. Proper evidence not found. Ask the national or regional health insurer.

Practical Steps Before You Book

1. Call your plan and ask the questions above, noting the date and name of the person you spoke with.
2. Ask the practitioner what they charge and how many visits are expected. [7]
3. Check the practitioner's licence first, since some plans may only pay licensed providers. We did not read a source that says so, so confirm it with your plan. See how to check a spa, clinic or independent therapist.
4. Be wary of a practitioner who promises that insurance "will definitely pay". See red flags in massage practice and marketing.
5. Compare costs on massage costs and tipping.

Massage Is Not a Replacement for Medical Care

If a doctor or physiotherapist has recommended hands-on treatment, ask whether it is a clinical service your plan covers. See coordinating complementary and medical care and massage and physical therapy compared. NCCIH advises not using massage to postpone seeing a health care provider about a medical problem. [7]