There are so many medical treatments and coverages that Medicare and Medicare products will cover. One of the treatments asked about frequently is chiropractic care. We get regular questions about Medicare coverage for this type of care.
For many chiropractic care is considered an alternative treatment to traditional medical practice. Yet millions of Americans routinely use chiropractic care in their standard health regimen. 14% of all chiropractic patients are over 65, so it is an important question to answer.
What is Chiropractic Care?
Chiropractic care is a form of medical treatment that focuses on the alignment of muscles and bones. Much of the focus is upon the spine and how it affects the working of your body.
If you’ve been to a chiropractor before, you are aware of how they manipulate your neck, spine and other joints. Many find relief from a wide range of symptoms by allowing the chiropractor to bring joints back into alignment. The pops and cracks in your joints is what most people think of when they picture spending time in a chiropractor’s office.
The most common treatment in a chiropractor is referred to as “spinal manipulation”. Sometimes they are referred to as “adjustments.” The purpose of this treatment for most is to relieve neck and back pain, and there is science to back up the results. Other joints and muscles such as hips and shoulders are areas where many patients find help.
Like medical doctors, chiropractors must be licensed to practice. Beyond adjustments, many chiropractors will also offer other services such as:
- Nutritional counseling
- Rehabilitation exercises
Does Medicare Pay for Chiropractic Treatment?
Yes. Medicare will pay for chiropractic treatment, but the criteria are very specific. Medicare coverage for chiropractic treatments will only cover a condition called spinal subluxation as well as some acupuncture.
Medicare Part A does not cover visits to the chiropractor because Part A is hospitalization coverage. Chiropractic care is a medical service and not an emergency procedure. It takes place in a doctor’s office, so any treatment Medicare covers will be covered under Medicare Part B.
There have been attempts to expand the definition of Medicare chiropractic coverage beyond just spinal subluxation. In 2018, the US House of Representatives introduced a bill to expand the type of chiro care that Medicare covers.
In January of 2020, federal law went into effect to cover acupuncture under Medicare. 12 sessions of acupuncture treatment can be covered, with an option to extend the course of treatment to 8 sessions. Extension can be made if the treatment is successfully reducing back pain.
How Does Part B Chiropractic Coverage Work?
If you have a chiropractic procedure, remember defined coverage is very specific to spinal subluxation. We will discuss and define that procedure late. Under Part B it is important to under the pay structure and what are the common services in a chiro office that are not covered:
- Chiropractic X-rays are not covered
- Massage therapy is not covered
- Acupuncture and other services offered by chiropractors are not covered
- You will pay 20% of the Medicare-approved amount
The Part B deductible will also apply. In 2021, the Part B deductible is $203.
Chiropractic care that will be covered is care that:
- Consists of manual manipulation of the spine
- Corrects a subluxation
- Deemed as medically necessary
What is Subluxation of the Spine?
Now for a little medical knowledge. We’ve talked about the only thing that can be covered by Medicare is “subluxation of the spine”.
Subluxation of the spine is when the bones of the spine (the vertebra) are separated or out of position.
Symptoms of subluxation can be neck pain, headaches, inability to move or stiffness.
There are many causes of subluxation. Because it is an inflammatory condition, it can be caused most commonly by trauma or internal causes that lead to inflammation. If you suspect you have these issues you should consult with a medical professional to properly diagnosis you.
If treated through chiropractic care, the practitioner will adjust your spine into proper alignment to relive the inflamed area.
Medicare Coverage for Acupuncture
Medicare Part B also may cover acupuncture under the care of a chiropractor. The coverage extends to 12 visits over a 90 day period to treat chronic low back pain.
Chronic low back pain is defined as:
- Last 12 weeks of longer
- No identifiable systemic cause such as metastatic issues, inflammatory or other infectious diseases
- Not associated with surgery or pregnancy.
Like subluxation treatment, it can be extended for an additional 8 sessions if the person is showing improvement. If no improvement can be proved, Medicare will not cover the extended sessions. No more than 20 sessions in a year will be covered.
Will Medicare Supplemental Insurance Cover Chiropractic Treatment?
Medicare supplemental insurance, also known as medigap, covers chiropractic treatment, but remember these policies are supplemental to Original Medicare and only pick up the gaps that Medicare does not cover.
Medicare Supplement policies are designed to help you with out-of-pocket costs than traditional Medicare does not cover. Supplement coverage is regulated by the federal government and comes in various levels of coverage. These plans from the most basic Plan A to the more comprehensive plans such as Plans F & G.
Under Medicare, you must pay your part B deductible, but there are other out-of-pocket costs. You will pay 20% coinsurance for all chiropractic appointments.
The average cost for a chiropractic adjustment is around $125. If you go for the 12 sessions, the total cost will be $1500.
After the Part B deductible, the cost will be:
- – $203
Medicare will cover 80%, leaving you with:
- X 20%
A Medicare supplement will pick up the 20% costs. Some plans, such a Plan F & C will cover the Part B deductible as well. Remember that Plan F & C, are no longer available to Seniors who were eligible for Medicare after 2000.
Will Medicare Advantage Plans Cover Chiropractic Care?
With Medicare Advantage Plans (Medicare Part C) coverage may be a little tricky, and depend on the plan you choose.
Advantage plans are not standardized like Supplement policies. Each plan can offer a different set of fees and benefits.
Plans that do cover chiropractic care beyond what Medicare covers are rare. But if you are interested an agent can search for a policy that offers that coverage. These plans can be expensive, so make sure that is a priority before you commit to one of the plans.
Advice for Medicare Chiropractic Coverage
One word of caution. If you are receiving chiropractic care, the provider may recommend services that are not covered by Medicare. As you have seen only certain services are covered. If they make recommendations such as a diagnostic test or other treatment make sure you understand exactly what will be covered by Medicare.
Don’t be afraid to ask the practitioner whether Medicare will cover the recommendations. This doesn’t mean you should not receive other tests or treatments, but understand what services you will have to pay out of pocket.
If chiropractic care is important to you when finding Medicare Supplements or Medicare Advantage plans, make sure to discuss with your agent.
At Medicare Nationwide, we represent hundreds of insurance companies throughout the United States and can quote those coverages based on your medical needs.
Make sure you discuss your medical history and what you are looking for in a policy. We can provide a variety of quotes, so you can make the best decision for your budget and health.
Prefer to chat by phone? Give us a call at 1-833-309-2125.
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