Medicare

Does Medicare Cover Chiropractic Care?

Chiropractic care fosters your body’s innate ability to heal and is very beneficial, especially as you age. Read on to learn if Medicare covers it and how to qualify.

Chiropractic Services

Chiropractic care is a branch of medicine that focuses on the body’s ability to heal itself. Chiropractors have earned a Doctor of Chiropractic degree, passed a national board exam, and have a state license. Many states also require continuing education classes.

If you receive chiropractic care, you can expect your doctor to review your health history and discuss your symptoms thoroughly. There may be x-rays and neuromuscular testing done to determine areas of weakness and pain. Treatment will focus on spinal adjustments for proper alignment. Chiropractors often prescribe exercises designed to strengthen specific muscle groups and maintain adjustments. Nutrition discussions can also play a role in a comprehensive treatment plan.

This approach to health care focuses on fostering your body’s innate ability to heal itself and is very beneficial, especially as you age and bones and joints suffer from years of wear and tear. If you want chiropractic services and are a senior, you might wonder if Medicare covers it.

Medicare and Chiropractic Services

Medicare covers chiropractic care, but there are usually some out-of-pocket expenses, and those will vary based on what type of Medicare coverage you have. Each plan is a bit different, so it’s best to check your specific plan to find out what your coverage includes.

Original Medicare

Original Medicare includes Part A and Part B coverage. Part A covers your hospital treatments, and since chiropractic is typically an outpatient procedure, it does not fall under part A. Part B Medicare is for outpatient care, and it’s the one you’ll look to for chiropractic coverage.

One stipulation for chiropractic care under Original Medicare Part B states that the care must be medically necessary. Typically you must have a primary doctor refer you to a chiropractor for treatment of spinal misalignment. Chiropractic care must focus only on spinal manipulation for that specific condition. Maintenance and preventative care are not covered.

There is a 20% co-payment with Medicare Part B, and you will be responsible for 20% of the charge for the adjustment. If you receive other treatments or modalities in combination with the adjustment, Medicare will not cover these services, and you may be 100% responsible for those costs.

Medicare Advantage

Medicare Advantage is sometimes referred to as Medicare Part C. Part C is not a part of Original Medicare, and it’s not offered by the government like Parts A and B are.

Private insurance carriers should offer you at least the same coverage that you would get under Parts A and B. Therefore, your plan will cover 80% of medically necessary chiropractic adjustments like Original Part B covers. But many Advantage programs offer more coverage than the base requirements provided by Original Medicare.

There might also be more reimbursement based on your specific Advantage plan benefits. Research into your plan is necessary to discover what your policy benefits are and if there is additional Chiropractic coverage.

Medigap/Medicare Supplement

One popular supplemental insurance for people with Original Medicare is Medigap. This insurance is an optional add-on and valuable when trying to fill in some gaps in coverage. You’ll have to purchase a Medigap plan separately, lowering your out-of-pocket medical expenses.

Medigap must follow the chiropractic restrictions that Medicare Part B has, meaning that the treatment must be medically necessary and only spinal manipulations to treat a specific condition are covered. If your treatment falls into these categories, your Part B will pay 80% of the charges after deductible, and then your Medigap plan steps in to help with that remaining 20%. There are different Medigap plans; some will cover the remaining 20% and even some of your deductible; others only cover 50% of your co-payment.

What Is Included in Medicare Coverage of Chiropractic Services?

Medicare Part B explicitly outlined that they will only cover medically necessary chiropractic care. That typically means you’ll need to see your primary care physician, who will have to detail your condition and why chiropractic care is the next best option for treatment. In many situations, this involves a spinal x-ray that will be covered if performed by your primary care provider.

At the chiropractor’s office, only manual manipulation of a spinal subluxation is covered by Medicare Part B. A subluxation is when your vertebrae are out of their natural alignment, causing impingement on nerves and blood vessels. Manual manipulation is also called an adjustment. During an adjustment, your doctor will use skilled hands-on techniques to shift the misaligned vertebra back into position.

What Is Excluded in Medicare Coverage of Chiropractic Services?

It is not uncommon for a chiropractor to perform diagnostic tests in the office to determine the level of subluxation and the related symptoms. Medicare Part B does not cover these tests, but an advantage plan does.

Similarly, many chiropractors prefer a well-rounded approach to treating the body. They may offer nutritional counseling, massage therapy, an exercise plan, and other services. Medicare Part B does not cover these treatments but might be in an Advantage plan.

What Do Chiropractic Services Cost?

While your costs will vary based on where you live, what treatments you receive, and your particular chiropractor, Palmer College of Chiropractic suggests that the following are common chiropractic service costs.

            First exam                               $36 – $63

            X-rays                                     $50 – $150

            Adjustments                            $29 – $36

Adjustments can also occur in different spine areas, each incurring a charge. Talking to your chiropractor will give you a better idea of your costs based on your physical situation.

Medicare Part B covers the adjustments you’ll have in a chiropractor’s office after you’ve reached your deductible at 80%. That means adjustments in the $29 – $36 will have an out-of-pocket cost to you of $5.80 – $7.20. Again, those estimates will change if you have an Advantage plan or Medigap coverage.

Benefits of Chiropractic Care

Chiropractic care is a cost-effective way to address health issues, especially if they’re associated with the spine. A chiropractic approach aims to treat the underlying cause of your problems and encourage the body to repair itself so the issue doesn’t return. This can be especially beneficial to an older population who has experienced years of wear and tear on their bones, muscles, and joints. Some benefits of chiropractic care include:

  • Improved posture
  • Relief of back and neck pain
  • Migraine and headache treatment
  • Pain relief without medications
  • Lessening of sciatica
  • Improved strength and flexibility
  • Reduction in numbness
  • Improved circulation
  • Relief from impinged nerves of the spine

Primarily, chiropractic care looks for misalignment in the spine and corrects it. Think of your spinal column as a garden hose; your spinal cord runs through it like water, full of nerves and blood vessels. The water doesn’t run as efficiently if there is a kink in your garden hose. Not only is there a problem in the lack of water coming out, but that build-up of restricted water can cause problems too.

Does Medicare Cover Other Pain Management Services?

Several other pain management and healthcare areas are affiliated with chiropractic treatments. You might find your chiropractor offers them in the office or refers you to an outside provider. Chiropractic treatment is part of your overall health care, and you might wonder if Medicare covers these extra services.

Physical Therapy

Physical therapy often works hand-in-hand with chiropractic care. While the chiropractor focuses on aligning your bones, your physical therapist will focus on strengthening the muscles in the surrounding area to help hold the alignment and to prevent it from happening in the future.

Medical professionals offer physical therapy to people in a hospital or skilled nursing facility, which would then require reimbursement from Medicare Part A. It isn’t a problem as long as it’s proven medically necessary.

Similarly, physical therapy done on an outpatient basis is covered by Medicare Part B when it’s medically necessary.

All Medicare Advantage programs must cover what Original Medicare does, which means it will cover medically necessary physical therapy under Advantage programs. You might find that your program covers more of your physical therapy charges than the required bare minimum.

Acupuncture

Acupuncture treats pain by inserting thin needles into strategic nerve points in the body. It’s a component of traditional Chinese medicine and has also gained popularity in Western culture.

Medicare Part B only covers acupuncture when used to treat chronic low back pain. You are allowed up to 12 acupuncture visits in 90 days. If you show improvement, you may receive an additional eight sessions, which amounts to 20 acupuncture treatments in 12 months. Only Part B covers it as it applies to chronic low back pain.

Because Original Medicare Part B only covers acupuncture in one situation, Medicare Advantage is only required to cover chronic low back pain also. However, some Advantage plans offer extended benefits when it comes to acupuncture. If this is important to you, it pays to research the available Advantage plans to find one that has a more lenient approach to acupuncture.