Medicare only covers chiropractic care services for manipulations to correct a misaligned spine. But, if you need care for a stiff neck or back pain, you can expect to pay for those services yourself. In the content below, we’ll go over when chiropractic care has coverage, how much care costs, and Medicare guidelines for services.
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Does Medicare Cover Chiropractic Care?
Manual manipulation of the spine by a chiropractor has coverage if it is medically necessary to correct a “subluxation.” Subluxation is a medical term for the misalignment of the spine.
You’ll need an official diagnosis as well as a qualified chiropractor to have this treatment covered by Medicare. When Medicare does cover chiropractic care, those services will fall under Medicare Part B.
What Chiropractic Treatments Will Medicare Not Cover?
Medicare doesn’t cover a visit to the chiropractor for reasons not deemed medically necessary. If you see a chiropractor for spine manipulation, you should be aware that Medicare won’t pay for it.
For example, Medicare won’t cover x-rays or acupuncture with a chiropractor’s orders. But, you’ll have coverage for the actual chiropractic treatment as long as you show improvement.
Medicare Guidelines for Chiropractic Documentation
A treatment plan should include a recommendation for the duration and frequency of visits. Also, the program should consist of specific treatment goals, objective measures to evaluate treatment effectiveness, and the date of initial treatment.
Do Medicare Advantage Plans Pay for Chiropractic Services?
Some Medicare Part C plans may include coverage for chiropractic treatments for a range of conditions. Every Advantage plan is different; look at your explanation of benefits to see what your policy covers. Not all Medicare Advantage plans will offer chiropractic coverage.
Do Medicare Supplement Plans Offer Coverage for Chiropractic Services?
Medicare Supplement plans (Medigap) cover the same services and procedures as Medicare. Medigap doesn’t include extra coverage beyond Medicare. However, Medigap plans can help with out-of-pocket costs such as coinsurance. If Medicare covers a Chiropractic service, your Medigap plan will pay its portion.
FAQs
How to Get Medicare Coverage for Chiropractic Care?
The only way to have Medicare cover chiropractic care is when you need spinal subluxation. Otherwise, for services like lower back pain, you could pay for the appointment yourself. But, you can expect to pay for most naturopathic doctors yourself. Now, on services Medicare does cover, Medigap can help eliminate some or all of the deductibles and coinsurances. Our agents can help you learn more about the benefits of Medigap, give us a call at the number above. Or, fill out an online rate form to explore available plans in your area.
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How much I am required to pay outof pocket for a Chiropractor visit? ( I am a medicare patient)
Is there a limit to the number of chiropractor for a medicare paitent?
Hi Pete! How much you pay out of pocket depends on which parts of Medicare you’re enrolled in. Original Medicare doesn’t come with copays, however, Medicare Advantage plans do. What that copay depends on which plan and carrier you enrolled with. You would need to contact them to find out. If you have Medicare Part B, the only out of pocket costs you’re responsible for is the 20% coinsurance. If you have Part B and a Medigap plan, you could pay zero out of pocket depending on the letter plan you enrolled in. There is no limit to the number of times you can receive coverage for chiropractic services. Your chiropractor just needs to provide Medicare with documentation of your treatment plan. Let me know if you have any more questions!
Lindsay, you are correct for participating providers, but my office is a non-participating provider. Non-participating providers may charge up to 15% over the Medicare approved amount and will generally ask for full payment at the time of service. The Medicare recipient will be reimbursed by Medicare only the 80% of the Medicare approved amount after the Medicare deductible is met. Depending on the type of secondary insurance a person has, they may get reimbursed the difference by their secondary plan.