The most important thing to know about chiropractic services and Medicare is that you are only covered for treatment to correct a spinal subluxation.
This occurs when one or more of the bones in your spine is out of place. This Medicare chiropractic benefit is provided by Part B.
Since this service is covered by Part B, it’s provided to both Original Medicare and Medicare Advantage beneficiaries.
Medicare Part B doesn’t cap the number of chiropractic visits it will cover if you’re receiving manual manipulation of the spine to correct a subluxation. It does, however, limit its coverage to only that service. If your chiropractor orders any other tests or treatments, you’ll probably need to pay out of pocket.
The good news? If you need another service related to your subluxation, like an X-ray, Medicare will typically accept these claims when ordered by a doctor instead of a chiropractor.
Many Medicare Advantage (Part C) plans may bundle chiropractic benefits into their policies. These can often include routine and preventive care, massage therapy and acupuncture.
Does Medicare limit chiropractic visits?
Medicare chiropractic coverage is very limited and doesn’t cover routine or preventive treatments. If you need chiropractic care for back pain, you’ll probably pay the full price of your treatments.
Starting in 2021, Medicare began to include acupuncture for lower back pain. Part B now will cover as many as 12 acupuncture sessions in 90 days. If you show improvement, eight more sessions can be approved. To be Medicare-approved, your acupuncture provider must:
- Have a masters degree or doctorate in Oriental Medicine or acupuncture (from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine).
- Have a current and unrestricted license to practice in the state the acupuncture is being provided.
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Medicare will help pay for chiropractic care if you need treatment for a spinal subluxation. At what rate does Medicare cover chiropractic care? Like other services covered by Part B, Medicare will pay 80% of your Medicare-approved care after you’ve paid your Part B deductible. You’ll be responsible for paying the remaining 20%, or coinsurance. Medicare Supplement Insurance (Medigap) can help cover some of these out-of-pocket costs since they fall under Part B.
If you have a Medicare Advantage plan, your plan may have different rates for chiropractic services. A GoHealth licensed insurance agent can help you compare plans and find one that meets your needs.
Can I find a chiropractor that takes Medicaid?
Depending on where you live, you may be eligible for chiropractic benefits under Medicaid. Medicaid is not the same as Medicare. It’s health insurance for low-income children, adults and families. Medicaid is paid for by the states, and each has different rules for eligibility and coverage. To find out which Medicaid chiropractor services are available where you live, call your local Medicaid office.
The list of chiropractic benefits covered by Medicare includes just one treatment: manual manipulation of the spine to correct a subluxation. You’re responsible for any other tests or treatments ordered by your chiropractor.
To be clear, Medicare may cover other tests and services around your subluxation, as long as they’re ordered by a doctor and not a chiropractor. For example — if your doctor orders X-rays to verify a subluxation, those tests can be covered by Medicare. If your chiropractor orders X-rays, Medicare won’t cover them.
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Yes. Medicare Advantage (Part C) replaces Original Medicare (Parts A and B) but offers the same Part A and B benefits or coverage as Original Medicare. That means Medicare Advantage enrollees can expect at least the same level of coverage as those with Parts A and B, including chiropractic care for a subluxation. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, prescription drugs and, yes, chiropractic coverage.