Is a chiropractor visit covered by Medicare?

Are you wondering, “Is a chiropractor covered by Medicare?” This comprehensive article has all the answers you need.

We delve into the key topics surrounding Medicare coverage for chiropractors, including what services are covered, limitations on coverage, and the costs involved.

• While Medicare does cover chiropractic services, it does not cover any additional testing
• If you need additional testing, your chiropractor may be able to refer you to another doctor so that Medicare will cover the costs
• Some Medicare Advantage plans offer routine chiropractic services as an additional benefit

Whether you’re seeking chiropractic care for pain management or alignment correction, understanding Medicare’s coverage is crucial. Don’t miss out on potential benefits or incur unnecessary expenses. Enter your ZIP code now to compare rates from the best insurance providers and ensure you make informed decisions about your chiropractic care coverage.

Does Medicare cover chiropractic care?

According to the American Chiropractic Association, around 80% of people experience back pain at some point in their lives. So if you’ve ever had to ask, ‘does insurance cover chiropractors?’ you’ll be happy to know that it’s a possibility.

Medicare covers a chiropractor specifically for manual manipulation of the spine to correct alignment. Original Medicare (Parts A & B) does not cover other services or tests ordered by a chiropractor, such as X-rays, massage therapy, or acupuncture.

Some Medicare Advantage plans (Part C) may provide additional chiropractic coverage.

Medicare covers chiropractic visits for any medically necessary manual manipulation of the spine. This includes diagnosing or treatment of an illness, injury, condition, or disease – or the related symptoms – as long as it meets accepted standards of medicine and as long as deemed necessary.

How much does a chiropractic visit cost with Medicare?

With Original Medicare, you will end up paying a 20% coinsurance for a chiropractic visit. Medicare Part B pays the other 80% of the Medicare-approved amount. The Part B deductible will apply as well.

Your costs may be different with a Medicare Advantage plan depending on your doctor and what type of treatment you may receive. A Medigap plan can also help cover these costs.

No matter what plan you choose, you will pay all costs for other services provided or tests that a chiropractor orders, including acupuncture, massage therapy, or X-rays.

Read more: Best Business Insurance for Massage Therapists

How do I find a chiropractor that accepts Medicare?

To start searching for the best doctors that accept Medicare, you’ll first want to decide on which plan to choose.

• Medicare Part B: helps people pay for doctor visits and some related treatments, covers some aspects of chiropractic care. Once a person meets their yearly deductible, Medicare will usually fund 80% of the cost for chiropractic treatment.
• Medicare Advantage, or Medicare Part C: an alternative to traditional Medicare, which private health insurance companies offer. Some plans may include greater coverage for chiropractic treatments than others. However, the level of coverage depends on the plans available.

Medicare Advantage may be part of a plan called a health maintenance organization or a preferred provider. These plans require the person to use in-network chiropractors that take Medicare to receive full reimbursement.

Case Studies: Medicare Coverage for Chiropractor Visits

Case Study 1: John’s Medicare Coverage

John, a Medicare beneficiary, sought chiropractic treatment for chronic back pain but was unsure if Medicare would cover it. After contacting his Medicare provider, John learned that Medicare Part B covers chiropractic services for the treatment of spinal subluxation. Armed with this knowledge, John was able to receive the chiropractic care he needed, covered by Medicare.

Case Study 2: Lisa’s Denied Coverage

Lisa, another Medicare beneficiary, visited a chiropractor to address her persistent neck pain. However, when she submitted her claim to Medicare, it was denied. Upon investigation, Lisa learned that Medicare only covers chiropractic services if they are deemed medically necessary and specifically related to subluxation of the spine. Since her treatment did not meet these criteria, Lisa’s chiropractor visits were not covered by Medicare.

Case Study 3: Mark’s Partial Coverage

Mark had a combination of Medicare Part B and a supplemental insurance plan. He regularly visited a chiropractor for a chronic condition, and initially, his chiropractor visits were fully covered by Medicare. However, due to limitations in his supplemental plan, Mark reached a coverage cap after a certain number of visits. As a result, he had to pay out-of-pocket for the remaining chiropractic treatments.

Mark’s case demonstrates the importance of understanding both Medicare and supplemental insurance policies to anticipate potential coverage limitations.

Case Study 4: Sarah’s Advantage Plan Coverage

Sarah enrolled in a Medicare Advantage plan, which is an alternative way to receive Medicare benefits through a private insurance company. Her plan included chiropractic services as part of its coverage. As a result, Sarah enjoyed the benefit of having her chiropractor visits covered by her Medicare Advantage plan, subject to the plan’s specific terms and conditions.

Case Study 5: Michael’s Non-Covered Services

Michael, a Medicare beneficiary, sought chiropractic care to alleviate hip pain. However, he soon discovered that Medicare does not cover chiropractic services for conditions unrelated to subluxation of the spine. Despite his pain, Michael had to pay for his chiropractor visits out-of-pocket since his condition did not meet the Medicare criteria for coverage.

Does Medicare cover chiropractors? The Bottom Line

While Medicare doesn’t cover additional tests like x-rays, massage therapy, or acupuncture if they are ordered by a chiropractor, Medicare does cover the cost for the treatment of lower back pain by a chiropractor.

If you need additional testing, your chiropractor may be able to refer you to another doctor so that Medicare can cover the costs.

Now that you’ve learned about how Medicare covers a chiropractor, shop around for coverage. Enter your ZIP code into our free tool below and start comparing quotes in your area.