Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Medicare will not pay for routine or maintenance chiropractic care, but in certain instances, Medicare will pay for chiropractic care to treat or correct an active acute or chronic condition. But with the potential benefits as a complementary health approach, you may want chiropractic care beyond what Medicare will cover. Read on to learn about what Medicare will cover and how you may find and get more coverage for chiropractic care.
Does Medicare Pay for Chiropractic Care?
Medicare will help pay for chiropractic care to actively treat or correct acute or chronic subluxation. Medicare defines chiropractic care as manual manipulation of the spine when a trained and licensed professional, such as a chiropractor, uses his hands or a small device to apply a controlled thrust to a joint. The thrust is a specific amount of force in a specific direction and moves the joint more than it could on its own. Subluxation is when you have a partially dislocated joint, and your bones are out of position or alignment.
Medicare is specific about when it will cover chiropractic care:
- It must be medically necessary; that is, you need a proven treatment provided by a skilled professional for your condition.
- You must have a neuromusculoskeletal (nerves, muscles, and bones) disorder that is documented in your medical record.
- Your chiropractor must provide documentation according to the Centers for Medicare and Medicaid Services (CMS) requirements and submit bills to Medicare using the correct codes (depending on how many areas of your back need adjustment).
- Your medical record must show that your condition is improving as a result of the treatment.
- Medicare does NOT pay for routine or maintenance chiropractic care.
- Medicare does NOT pay for other services that your chiropractor might order, such as x-rays, acupuncture, or massage.
What Parts of Medicare Cover Chiropractic Care?
|Original Medicare Part A (hospital insurance) and Part B (medical insurance): Part A does not cover chiropractic care. Part B covers chiropractic care as defined above at 80%, whether you are in an outpatient or inpatient setting after you pay your annual deductible. If you get your services in a hospital outpatient clinic or department, you may have to pay an additional copay or coinsurance to the hospital.|
|Medicare Part C (Medicare Advantage) pays for Medicare-covered chiropractic care with the same restrictions as Original Medicare, but the cost-sharing structure may differ. For instance, you may pay a copay instead of a coinsurance percentage. Depending on your plan, you may need prior authorization and a referral to an in-network chiropractor before your plan will pay.
Some Medicare Advantage Plans offer routine or maintenance chiropractic care (a non-covered Medicare service) as a supplemental benefit. Contact your plan directly or review your Evidence of Coverage document to find out if your plan does. Or, you can ask your chiropractor which insurance companies they are in-network with and bill regularly for routine chiropractic care.
Medicare Supplement plans
|Medicare Supplement Insurance (Medigap) generally helps pay the Original Medicare Part B coinsurance of 20% for Medicare-covered chiropractic services after your deductible is met. If you already have Plans F or C, your Part B deductible will be covered. If you have Plan N, you will pay a copay for each visit to your chiropractor.|
Does Medicare Cover X-rays for Chiropractic Care?
Medicare does not cover x-rays ordered by your chiropractor. However, x-rays may be covered by Medicare Part B if ordered by a physician to diagnose a medical condition. For instance, if you visit your primary care physician because you are experiencing low back pain, she may order a diagnostic x-ray. Your chiropractor can refer to the x-ray in your medical record to help determine your treatment plan with your permission.
How Do You Change Your Medicare Plan for Better Chiropractic Coverage?
If you have Original Medicare, your chiropractic coverage is limited, and you incur a 20% coinsurance when you get Medicare-covered chiropractic care. You can either:
- Switch to a Medicare Advantage Plan that has more chiropractic coverage beyond what Medicare will cover. Some plans offer supplemental benefits for routine or maintenance chiropractic care. You may pay a higher monthly premium and copays or coinsurance for the supplemental benefits depending on the plan. OR
- Purchase a Medigap plan to help cover the coinsurance payments if you can find an insurance carrier in your state that will sell you a plan. If you missed your opportunity to purchase a Medigap plan during your Initial Enrollment Period or your Medigap open enrollment period, you might need to go through the process of medical underwriting and may pay more to get a plan.
You can change your Medicare Plan for better chiropractic coverage during specific enrollment periods:
- Annual Open Enrollment (October 15 through December 7) if you already have Medicare Part A and B. You can join a Medicare Advantage Plan that offers supplemental coverage for chiropractic care. Your new plan will take effect on January 1 the following year.
- Annual Medicare Advantage Open Enrollment (January 1 through March 31) if you want to switch from your current Advantage plan that doesn’t offer supplemental coverage for chiropractic to one that does. Your new plan will take effect the month after you make the switch.a physician orders them
Learn More From Our Sources
- CMS | Medicare Requirements for Chiropractic Coverage | Last accessed October 2021
- CMS | Chiropractic Services Fact Sheet | Last accessed October 2021
- Medicare | Chiropractic Services Coverage | Last accessed October 2021
- Medicare | Medicare and You 2022 Handbook | Last accessed October 2021
- Medicare | What Medicare Covers | Last accessed October 2021
- Medicare | Find and Compare Medicare Plans | Last accessed October 2021
- Medicare | When Can I Buy a Medigap Plan? | Last accessed October 2021
- NIH | Spinal Manipulation: What You Need to Know | Last accessed October 2021