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Medicare Coverage for Chiropractic Services: What to Know

3 mins read
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Chiropractic care focuses on treating spinal and musculoskeletal problems. It’s a popular choice for those looking to alleviate pain and improve mobility. This approach to health is gaining ever more recognition for its long-term benefits.

Understanding whether Medicare provides coverage for chiropractic services is essential, especially for those who rely on this type of care for better health and well-being. 

This article aims to demystify Medicare coverage of chiropractic treatments, offering insights into the nature of these treatments, the conditions they address, and their role in promoting overall wellness. We’ll explore Medicare’s coverage criteria for chiropractic care, including any limitations and out-of-pocket costs, to provide essential guidance for beneficiaries considering these treatments.

Understanding Chiropractic Care

Chiropractic care addresses a variety of health issues like back pain, neck pain, and headaches, among many others. It uses manual manipulation techniques to adjust the spine and thereby improve function and reduce pain.

These treatments play a significant role in overall wellness, leading to improved posture, enhanced mobility, and reduced discomfort. Chiropractic care plays a key role in promoting long-term health and preventing potential future health issues.

Does Medicare Cover Chiropractic Care?

Medicare provides coverage for chiropractic services primarily for one procedure: manual manipulation of the spine to correct a spinal subluxation (partial dislocation). Medicare covers this specific treatment because it can lead to discomfort and affect nerve function.

Beneficiaries must understand that Original Medicare (Part A and Part B) does not extend this coverage to other services or tests a chiropractor might order. This includes procedures like X-rays, massage therapy, acupuncture, or physical therapy. If you require these services, you may need to cover these costs out-of-pocket or through additional insurance.

The criteria for Medicare coverage of chiropractic treatments are strict. It covers chiropractic care only when it is deemed “medically necessary,” which means it must be essential for diagnosing or treating a medical condition and meet accepted standards of medical practice.

Another key point is that chiropractic coverage specifics can vary for those enrolled in Medicare Advantage plans (Part C). These plans might offer broader chiropractic coverage, so beneficiaries should check directly with their plan provider.

Original Medicare beneficiaries typically pay 20% of the Medicare-approved amount for chiropractic services after meeting the Part B deductible. The cost-sharing structure can differ with Medicare Advantage Plans, so we recommend consulting directly with your plan provider for a comprehensive understanding of your coverage.

While Medicare does cover chiropractic care for spinal manipulation, beneficiaries should be mindful of the coverage limitations and potential out-of-pocket costs for additional services associated with chiropractic care.

What is Subluxation of the Spine?

Subluxation of the spine is a key term in understanding chiropractic care and its coverage under Medicare. This condition occurs when one or more of the bones in the spine move out of position and create a misalignment. This misalignment can cause discomfort or pain and affect nerve function, leading to various symptoms like headaches, stiffness, or even more complex nervous system issues.

Medicare’s coverage for chiropractic services primarily focuses on the treatment of spinal subluxation through manual manipulation or adjustment of the spine. This specific treatment is essential because it directly addresses the root cause of spinal subluxation-related discomfort. Chiropractors use their hands to apply a controlled, sudden force to a spinal joint to improve spinal motion and enhance physical function.

The reason Medicare covers this particular treatment is because of its potential to alleviate extended symptoms associated with spinal subluxation. By correcting this misalignment, chiropractic care can reduce pain and improve mobility. This significantly enhances the quality of life for those affected.

At CoverRight, we’re your trusted partner in navigating Medicare coverage. We help you understand and optimize your benefits for chiropractic care and beyond.

Frequently Asked Questions

Is chiropractic care covered under Original Medicare (Part A and Part B)?

Yes, Original Medicare covers chiropractic care but only for manual manipulation of the spine to correct a spinal subluxation. This is the only chiropractic service that Medicare Part B will pay for.

What conditions or criteria must be met for Medicare to cover chiropractic services?

For Medicare to cover chiropractic services, a medical professional must deem the chiropractic treatment medically necessary for treating a spinal subluxation. The chiropractor providing the service must be a Medicare-recognized provider.

Are there any out-of-pocket costs for chiropractic care with Medicare?

Yes, there are out-of-pocket costs. Under Original Medicare. You are responsible for 20% of the Medicare-approved amount for chiropractic services after meeting the Medicare Part B deductible. It’s essential to be aware of these costs before seeking treatment.

How often can I receive chiropractic treatments under Medicare?

Medicare does not set a specific limit on the number of covered chiropractic care visits. Healthcare providers must continue to consider chiropractic treatments as medically necessary for Medicare to cover them. It’s crucial to consult with your healthcare provider to understand the appropriate frequency of visits for your condition.

Can I use a Medicare Supplement Insurance (Medigap) plan for additional coverage?

Yes, a Medigap plan can help cover some of the out-of-pocket costs associated with chiropractic care under Medicare. Medigap plans can cover coinsurance and deductibles, reducing your share of the costs for covered chiropractic services.

Richard Chan

Richard is the Founder of CoverRight and based in New York. He is passionate about empowering consumers to take control of their health and finances. Prior to starting CoverRight, Richard had extensive experience working in financial services with over 8 years' experience in consumer lending and investment banking.

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