Does Medicare Cover Chiropractic Care?
Medicare Benefits Solutions
Jul 17, 2020
Visiting your chiropractor can be an essential part of your care plan to manage pain you have; however, chiropractors can be expensive, especially if you have to go several times a month. Many Medicare recipients wonder if their Medicare benefits will cover chiropractic care. While Medicare usually does not cover chiropractic care and acupuncture, you may have some coverage of care depending on your specific circumstances.
Medicare Part B and chiropractic care
If you have Part B, it may cover some of your chiropractic care if it is deemed medically necessary. Medicare defines a procedure or service as being medically necessary when they are: “health care services and supplies needed to diagnose to treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
When you talk about Medicare coverage and chiropractic care, the only condition that Medicare deems medically necessary for chiropractic care is subluxation. If you have any other reason for needing to visit the chiropractor, Medicare most likely won’t pay for it.
Subluxation is a medical condition where a single or multiple bones in your spine pop or grow out of their correct position. People who have this condition can feel pain in their neck and back with headaches, and the pain will slowly start to go up over time as you aggravate your spine.
The degree of pain you feel with a subluxation can fluctuate from a very minor discomfort that you can live with to pain that prevents you from going about your daily tasks and normal life. Occasionally, you’ll feel so much pain from this condition that it makes it very difficult to move at all. At the start, you may notice that you have some inflexibility and stiffness, and these conditions will slowly get worse because you’re in too much pain to stretch out your muscles or exercise.
Since this is a medically necessary reason for Medicare to pay for your chiropractor visits, your doctor may have to prescribe them. They have to document that you need chiropractor visits as part of your treatment plan to help you live a more fully active life. Many Medicare Advantage plans require you to have a written referral from your primary care physician or specialist before they cover the cost.
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Additionally, your referral has to come from your primary care doctor or a specialist. You can’t get one from your chiropractor. Medicare will only pay for your chiropractic treatments. If you need other services like X-rays that are not included in your Part B coverage, you’ll have to cover the cost on your own. Medicare also won’t pay for acupuncture or massage therapy if your chiropractor recommends it as part of a treatment plan.
Medicare will cap the number of treatments you can have in every plan year. This cap can be less or more than your chiropractor and doctor recommends you have. Your chiropractor has to be Medicare-certified, and not all of them have this certification. If you go to a chiropractor that isn’t Medicare-certified, your benefits won’t pay for your treatment. If they do pay, they’ll pay up to 80% of the Medicare-approved cost. You may be able to get help paying your coinsurance if you have purchased Medigap insurance and have Original Medicare.
Your traditional Medicare benefits will cover chiropractic care if you have a subluxation, but there are strict rules that must be followed. Medicare Advantage plans include the same Part A and Part B benefits as Original Medicare, but some may include a more broad range of chiropractic care.
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