Back problems can cause chronic pain and discomfort, and those problems tend to worsen as you get older. In addition, many people with disabilities have back problems that require chiropractic services for treatment. So, does Medicare cover these visits to the chiropractor? The answer usually depends on the type of treatment you are receiving. Medicare Part B covers some chiropractic services but not others. If you are a Medicare beneficiary, then keep reading. We will give you all the details you need to know about Medicare coverage of chiropractic services.
Does Medicare Cover Chiropractic Care?
Yes, Medicare Part B covers chiropractic care, but only under certain circumstances. Original Medicare provides coverage for manual manipulation of the spine to correct a spinal subluxation. This basically means that Medicare will cover the service for a chiropractor to manually manipulate your spine to treat back pain. However, there are some conditions. The treatment must be medically necessary, and you must have active back pain. Medicare will not pay for preventive chiropractic treatments or maintenance services. The other important piece to note is that the treatment must be medically necessary.
For the treatment to be deemed medically necessary, you generally need to visit your doctor first. If your physician orders a chiropractic visit as part of your treatment, then Medicare will cover the spinal manipulation required for the treatment. Without this referral from your doctor, the chiropractor visit might not be covered. If the chiropractor orders additional services, like an X-ray or massage therapy, those additional services are not generally covered by Medicare. We will discuss the exceptions to covered services later in this article.
Medicare Coverage For Chiropractic Services
So, does Medicare cover chiropractors? You likely already know that there are many parts of Medicare. Each part provides coverage for different medical services, so which parts cover chiropractor visits? Here is what you need to know about how each part of Medicare handles chiropractic services.
— Medicare Part A
Medicare Part A does not provide chiropractic coverage. Your Part A benefits provide coverage for hospital stays and inpatient services. Part A is considered hospital insurance. Since chiropractic services are not provided on an inpatient basis, your Part A coverage will not apply to your chiropractor visits. If you are only enrolled in Medicare Part A, then you will incur an out-of-pocket cost for the full price of the visit.
— Medicare Part B
Medicare Part B is the medical insurance that provides all the chiropractic coverage mentioned earlier in this article. Part B pays for manual manipulation of the spine by a chiropractor for the treatment of active back pain. As with other Part B outpatient services, it will cover 80% of the Medicare-approved amount. You will still be responsible for paying your Part B deductible as well as any necessary coinsurance amounts. There is typically no copay associated with a chiropractor visit, but you are responsible for paying 20% of the service fee.
— Medicare Part C
Medicare Part C allows you to combine all your Original Medicare coverage into a single plan. You might also hear this coverage called a Medicare Advantage plan. These plans are managed by private insurance companies who are allowed to set their own coverage rules, although the plans must provide at least the same minimum level of coverage as Original Medicare. This means that your Medicare Advantage plan must cover the same chiropractic services as Medicare Part B.
Many Advantage plans provide additional benefits beyond what Medicare typically covers. Some of the best Medicare Advantage plans include coverage for additional services, like massage therapy or acupuncture. You should refer to your plan details to see the coverage specifics for your plan. Many plans require the use of an in-network healthcare provider to receive full benefits. Therefore, you should make sure that the chiropractor you plan to visit is in your health insurance plan’s network so that you receive full benefits. Some people wonder, “Do chiropractors take insurance?” Not all chiropractors accept insurance, so you should verify with your provider whether they accept insurance before your visit.
— Medicare Part D
Medicare Part D provides prescription drug coverage for Medicare beneficiaries. This coverage could include regular medication that is taken daily or medication that is prescribed once to treat a specific illness. However, Part D does not cover chiropractic services. If your doctor prescribes medication to treat your back pain, then Part D would likely provide coverage for the medication.
— Medicare Supplement Insurance
Medicare supplement insurance, or a Medigap plan, will usually provide some coverage for chiropractor services. Medigap is private insurance that you can choose to purchase that will help pay out-of-pocket costs not covered by Medicare. This includes your Part B copays and coinsurance payments. Since Part B covers some chiropractor visits, you could use a Medigap plan to help cover the cost of your coinsurance for those visits. The coverage specifics vary depending on which Medigap plan you have purchased. The average cost of a Medigap plan generally depends on the level of coverage provided, so the more expensive plans tend to provide more coverage.
Limitations On Medicare Coverage Of Chiropractic Visits
We’ve already touched on the fact that enrollment in Medicare does not guarantee coverage of all chiropractic services. So, which services are excluded from coverage? First, any services that are not medically necessary will not be covered. In general, the service performed must be for the treatment of active back pain. Even manual manipulation of the spine will not be covered if it is done as a preventive measure or as a maintenance service. Similarly, additional services beyond the spinal manipulation that might be ordered by the chiropractor will not be covered. These services could include ultrasounds, traction therapy, or massage therapy.
Acupuncture is not typically covered by Medicare, although it can be covered in some cases if it is used for the treatment of chronic low back pain. X-rays or other diagnostic tests ordered by a chiropractor will not be covered, although those items might be covered if they are ordered by a doctor.
When it comes to the frequency of treatments, there is no limit to the number of chiropractor visits that Medicare will cover. However, each treatment must be medically necessary. The severity of the pain or problem can often have a big impact on whether or not subsequent visits continue to be covered by Medicare. As your pain subsides, the treatments will likely become less necessary, and Medicare will likely eventually stop paying for those treatments unless intense pain continues.
The Bottom Line
Medicare Part B provides benefits that cover chiropractic services, but only in certain situations. The Medicare options that provide coverage are Medicare Part B, Medicare Advantage, and Medigap. Part B covers only manual spinal manipulation for active back pain. It does not cover massage therapy or other services ordered by your chiropractor. However, many Medicare Advantage plans provide additional coverage. You might also choose to use a Medicare supplement plan to help pay for coinsurance amounts and copays that are not covered under Part B.
Frequently Asked Questions
How many chiropractic visits does Medicare pay for?
Medicare will pay for an unlimited number of chiropractic visits, but each visit must be deemed medically necessary. You can learn more about Medicare chiropractic coverage at Medicare.gov. Your Part B coverage will pay for a chiropractor or other qualified provider to manually manipulate your spine to treat a spinal subluxation. You must have active back pain, as preventive treatments are not covered.
Does Medicare pay for massages?
No, Original Medicare does not pay for massages. However, some Medicare Advantage plans might provide coverage for massage therapy in some situations. Since the coverage details of those plans vary, you would need to check your specific plan to determine whether massage therapy would be covered. If that coverage is important to you, then you should work with a licensed insurance agent in your local area who can assist with finding a Medicare Advantage plan that will fit your needs.
Does Medicare pay for a chiropractic exam?
No, Medicare does not pay for diagnostic tests or exams performed by a chiropractor. The only chiropractic service covered by Medicare is the manual manipulation of the spine to treat active back pain. The service must be medically necessary, and other services ordered by the chiropractor are generally not covered. Some Medicare Advantage plans provide this coverage, so you should check your plan details to determine whether your Part C plan would cover a chiropractic exam.