Medicare will cover chiropractic care in specific circumstances when a doctor deems the service as medically necessary. Medicare Part B will only cover chiropractic services for manual manipulation of a spinal subluxation; this refers to a technique used to manually adjust the vertebrae of the spine.
If you have a Medicare Advantage Plan (Medicare Part C), it may offer additional services past what Original Medicare (Part A and Part B) covers.
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The Benefits of Chiropractic Care
Chiropractic care is a branch of medicine that focuses on the body’s ability to heal itself. Primarily, chiropractic care looks for misalignment in the spine and corrects it. This approach to healthcare can be very beneficial, especially as you age and bones and joints suffer from years of wear and tear.
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
If you receive chiropractic care, you can expect your doctor to review your health history and discuss your symptoms thoroughly. X-rays and neuromuscular testing may be done to determine areas of weakness and pain.
Treatment will focus on spinal adjustments for proper alignment. Additionally, chiropractors often prescribe exercises designed to strengthen specific muscle groups and maintain adjustments. Nutrition discussions may also play a role in a comprehensive treatment plan. Many of these treatments will likely not be covered by Original Medicare.
Understanding Medicare Coverage for Chiropractic Care
Medicare covers some chiropractic care, but there are usually some out-of-pocket expenses, and those will vary based on what type of Medicare coverage you have. If you have Original Medicare, you’ll see limited coverage through Medicare Part B and usually no coverage through Medicare Part A.
Eligibility
For Medicare to cover chiropractic services, your doctor must deem the service medically necessary. Medicare will only cover chiropractic services for manual adjustment of the vertebrae in the spine that are out of position. This service is also referred to as correction of a spinal subluxation.
Spinal manipulation can be used to treat lower back pain, neck pain, headaches, and sciatica. Once again, however, your doctor must deem the chiropractic care necessary for it to be covered.
Medicare Part A Coverage
Medicare Part A is coverage for inpatient services and hospital stays. Medicare Part A does not usually cover any chiropractic services. However, Medicare Part A may cover the service if you are in the hospital for another issue, such as a car wreck, and a manual spinal subluxation is needed.
Medicare Part B Coverage
Medicare Part B is coverage for outpatient services such as doctor visits, physical therapy, in-home care, and medical equipment. Should your doctor deem that a spinal subluxation is medically necessary, Medicare Part B is the portion of your insurance that would cover the services.
It is important to note that Medicare Part B does have a deductible of $226 per year; after that deductible is met, there is a 20% copay on services. Also, you must find a chiropractor that accepts Medicare as payment or the entire service will be out of pocket.
Medigap Coverage
One popular supplemental insurance for people with Original Medicare is Medigap. 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 the deductible, and then your Medigap plan can step 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 copayment.
Coverage Exclusions
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 Medicare Advantage Plans may.
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. Original Medicare does not cover these treatments.
How Does Medicare Advantage Cover Chiropractic Care?
Medicare Advantage Plans 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. However, many Medicare Advantage programs offer more coverage than the base requirements provided by Original Medicare.
There might also be more reimbursement based on your specific plan benefits. Research your plan to discover what your policy benefits are and if there is additional chiropractic coverage.
How Much Does Going to the Chiropractor Cost With Medicare?
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.
Cost | |
|---|---|
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 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 a Medicare Advantage Plan or Medigap coverage.
Original Medicare will not cover your exams, X-rays, or any additional treatments beyond adjustments. You must pay for these services out of pocket.
Medicare Advantage Costs
If you have a Medicare Advantage Plan, the out-of-pocket expense you can expect will vary greatly depending on your individual plan. Private companies sell these policies and must cover all services that Original Medicare Part A and B cover, and often offer additional services that Medicare does not.
If chiropractic care is important to you, you may be able to find a Medicare Advantage Plan that offers additional coverage. Talk to a licensed Medicare agent or call the insurer of your choice to discuss your options.
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.
- Physical therapy: Medical professionals offer physical therapy to people in a hospital or skilled nursing facility, which would then require reimbursement from Medicare Part A. Similarly, physical therapy done on an outpatient basis is covered by Medicare Part B when it’s medically necessary.
- Acupuncture: 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.
All Medicare Advantage Plans must cover what Original Medicare does, which means it will cover medically necessary physical therapy and acupuncture under MA programs. You might find that your program covers more of your charges than the required bare minimum.
How to Navigate Chiropractic Care With Medicare
If you have Medicare and need to see a chiropractor for a covered service, it is essential to take the following steps for a more straightforward overall process:
- Find a Medicare-approved chiropractor. It is important to find a chiropractor that is approved through Medicare and accepts Medicare as payment. You can go online to Medicare.gov to find Medicare providers in your area.
- Review your coverage before your appointment. Before going to your appointment, review your plan. This will give you a better idea of what will be covered and what you can expect to pay out of pocket.
- Understand the fine print. Remember that Original Medicare will only cover a manual spine subluxation under chiropractic services. Any other tests or services performed at your visit will not be covered. If you have a Medicare Advantage Plan, contact your health insurance provider for a detailed review of what will and will not be covered to avoid any unexpected costs.
All in All
When it comes to Medicare and chiropractic services, Medicare will only cover a manual adjustment of vertebrae in the spine. This procedure must be considered medically necessary by your doctor and should be performed by a Medicare-approved provider. Additional chiropractic services may be offered if you have a Medicare Advantage Plan.
Before you make an appointment, reviewing your plan for coverage details is essential. Knowing what is and is not covered will help reduce out-of-pocket expenses and unexpected costs.