Does Medicare Cover Chiropractic Care / Services?
Yes, when deemed medically necessary, Medicare does cover chiropractic services. Original Medicare Part B pays for 80% of the cost of chiropractic services. You will pay the other 20% is the co-insurance – unless you have supplemental insurance.
“Medically necessary” chiropractic care is defined as manual manipulation of the spine to correct a subluxation by a qualified provider such as a chiropractor. (Medicare.gov source info).
What is a Subluxation?
A subluxation is when one or more of your bones moves out of position. In other words, your spinal vertebrae are out of position or misaligned. According to experts, this can cause back or neck pain, headaches and immobility.
Chiropractors can manipulate the spine to correct these misalignments and alleviate pain. This is Medicare’s expected use of chiropractic care.
How Much Does Medicare Pay for Chiropractic Adjustment?
When used for a Medicare approved reason, Medicare will pay for 80% of the cost of your chiropractic care. However, since it is part of Original Medicare Part B (Doctor / Professional Services), the Medicare Part B Deductible will apply.
There is no cap on the amount of times you can see the chiropractor in a year with Original Medicare. However, you have a Medicare Advantage Plan or a supplement plan, there may be different rules.
Let’s look at each of those extra insurances to see how they work with Medicare Part B.
Does Medicare Advantage Pay for Chiropractic Care?
The US Government and CMS (the Center for Medicare / Medicaid Services) requires Medicare Advantage Plans to cover at least what Original Medicare covers. So yes, Medicare Advantage plans will have some benefit for chiropractic care.
It will depend on each individual plan what that looks like. Some plans have a co-pay or co-insurance due each time you use the chiropractor. Also, some may have a cap on fully covered care. Finally, some plans may require a referral from a PCP (Primary Care Physician), so make sure to check with your plan for coverages and options.
Does Medigap Pay for Chiropractic Care?
Medigap (which is also called Medicare Supplement) Plans help to cover costs where Original Medicare leaves off. Some of them cover all extra costs and co-insurances not paid by Original Medicare.
As mentioned earlier, chiropractic services are covered with Medicare Part B. To see what a particular supplement will cover, you will need to look at how they cover the uncovered costs of Part B. For example:
- Medigap Plan F covers all costs that Medicare does not. (This includes the Part B yearly deductible.) So, if you have Plan F, you will not pay any co-pays or co-insurances to see a chiropractor for approved care.
- Also, read “Is Medicare Plan F Going Away?”
- Medicare Plan G also covers all costs that Medicare does not – except for the Medicare Part B yearly deductible. So, if you have Plan G, you would first pay the Part B deductible for rendered and approved services. Then, once that deductible was satisfied, you would not pay anything else for your services.
- Other Medigap Plans cover some or all of the Part B coinsurances. If you want to see a chart and in depth explanation of each Medicare Supplement Plan, please click here.
A note of warning from Medicare.gov:
“Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture (except for low back pain). If you think your chiropractor is billing Medicare for services that aren’t covered, you can report suspected Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227). TTY: 1‑877‑486‑2048.”https://www.medicare.gov/coverage/chiropractic-services#
Conclusions on Medicare Coverages of Chiropractic Care
- Yes, if you have Medicare Part B, you are entitled to 80% coverage of your Medicare approved uses of the chiropractor (after your yearly Part B Deductible applies).
- If you have additional coverage, through a supplement or a Medicare Advantage Plan, you may have additional coverage for the remaining 20%.
- If you have questions on whether or not your care will be considered a covered service, you can talk with your primary care physician, directly to Medicare, or if you have additional insurance, to your private insurance company. They can also give you a better idea of your actual costs – including any co-pays, deductibles or co-insurances.