Chiropractic care is covered by Medicare Part B if deemed medically necessary. Below we discuss when treatment is covered and which specific Medicare plans provide coverage for chiropractic care.
Overview Of Treatment
Chiropractors attempt to treat musculoskeletal disorders and nervous disorders without using any types of drugs. They achieve this by manipulating and adjusting the spine by hand. A chiropractor can improve the general health of a person by reinstating the spine’s structure and reducing pressure on neurological tissue. Sudden force may be used during a chiropractic treatment to improve the range of motion in a certain part of the body.
A chiropractor may also help with back pain. In addition, they can teach patients basic beneficial exercises, therapies, and ergonomics that will reduce suffering. Sometimes, chiropractors engage in nutritional counseling as part of their treatment plan.
The American Chiropractic Association reports that about 80% of the people in the world struggle with back pain at some point. Yearly, more than 22 million people visit chiropractors in America. About 33% or 7.7 million of these people are hoping to prevent or get relief from back pain.
What Can Chiropractic Care Help with?
Conditions that require the help of a chiropractor include:
- Back pain and low back disorders
- Neck pain
- Migraines and Headaches
- Numbness, pain and or tingling in the arms or legs (Sciatica or arthritis)
- Muscle, joint, or tendon disorders. Causes of these pains could range from accidents (car, motorcycles, etc.) and sports injuries all the way to muscle and joint strains.
What Medicare Plans Cover Chiropractor Visits?
If you have Original Medicare (Part A and Part B) , your plan may cover a chiropractor’s service.
There is a condition called spine subluxation. A state in which bones are out of position. The only time your Medicare covers a chiropractor’s services is to correct a spinal subluxation.
If you have this condition and have met your annual deductible, your Medicare covers about 80% of the Medicare-approved fees. However, you have to pay for the remaining 20% as well as the Part B deductible.
With Original Medicare (Part A & Part B) you will not be required to have a referral to see a chiropractor. However, if you have a Medicare Advantage plan a referral may be necessary.
Medicare Part A
Your Original Medicare Part A should cover inpatient services, home care, and skilled nursing facility services. Since Part A covers mainly hospital care, it does not account for visits to the chiropractors.
Medicare Part B
With Original Medicare Part B your visit to the chiropractor is covered. However, the coverage applies if it is medically required to correct a subluxation. Medicare Part B coverage includes emergency services, outpatient services, some prescription drugs, preventative services, and medical equipment. Preventative services covered by Part B include flu shots, Hepatitis screenings, HIV screening, and mental health services.
Your chiropractor may order specific diagnostic tests. The tests may include X-ray, acupuncture, or massage therapy. In this case, you may have to pay out-of-pocket as your Medicare will not cover the costs. Although, if you did prior X-rays to be sure that you have a subluxation, your Medicare would cover the tests.
Medicare Advantage
Medicare Advantage, known as Medicare Part C, may cover your visit to the chiropractor. Private insurance companies sell Medicare Advantage plans.
There are several Medicare Advantage plans, and they all offer a range of benefits that slightly differ from each other. Some Medicare Advantage plans may provide benefits that go beyond chiropractor’s visit for a subluxation correction.
If you have a Medicare Advantage plan, check with your provider to find out which other chiropractic services you are entitled to.
Acupuncture – An Alternative Treatment Option
Medicare Part B coverage includes braces for your neck, arm, legs, and back, if medically required. The insurance covers up to 80% of the Medicare-approved cost. Medicare will also pay for your wheelchairs when medically necessary. Although, some power wheelchairs may need prior authorization before coverage applies.
In January 2020, the Center for Medicare and Medicaid Services (CMS) announced that Medicare will now cover acupuncture. Medicare acupuncture coverage applies if:
- If back pain is severe or chronic
- The pain has lasted for 12 weeks or more
- The cause is unknown, and it is not related to pregnancy or surgery.
The Medicare coverage will pay for up to 12 sessions within 90 days. The treatment may stop if the patient’s situation does not improve. If the patient improves, Medicare will pay for eight more acupuncture sessions. The maximum amount of acupuncture sessions that Medicare covers annually is twenty.
How a Medicare Supplement Plan Can Help
If you need to visit a chiropractor, you still need to pay 20% of the Medicare-approved fee out-of-pocket. You also need to pay the part B annual deductible. However, a Medicare Supplement plan may be able to help with this so you avoid paying high costs.
There are several Medicare Supplement plans available, and each of them offers a standardized series of benefits. Compare several Medicare plans to see which one is best for you if you need chiropractic care.
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If you have any questions or inquiries about your Medicare insurance or Medicare Supplement Plans, feel free to reach out to us at 800-208-4974. Our Licensed Insurance Agents will be glad to help you out.
