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Chiropractic care may be necessary for seniors who are experiencing muscle and joint problems. While Medicare covers most medical services for seniors over 65, some treatments are excluded from Medicare coverage. Talking about chiropractic treatment, Medicare will only cover it in specific cases.
Does Medicare pay for chiropractor?
Medicare will only cover chiropractic care if it is the treatment for spinal subluxation. This condition occurs when the bones in the spine are separated. Patients suffering from spinal subluxation may require chiropractic adjustment to treat the condition. In such a case, the treatment will be covered by Medicare under your Part B benefits.
Chiropractic procedures like massage therapy or acupuncture are not covered by Original Medicare. However, if you have a Medicare Advantage plan or Medicare Part C, your plan benefits may include coverage for chiropractic services.
How does Medicare cover chiropractic care?
Medicare Part A: Part A benefits only cover hospitalization care and therefore will not include any coverage for chiropractic care.
Medicare Part B: Medicare chiropractic coverage falls under Part B benefits which include outpatient care and services. When chiropractic adjustment is necessary to treat spinal subluxation, Medicare Part B will cover the cost of this treatment. However, keep in mind that your Part B deductibles and copays will apply.
Medicare Advantage: Medicare Advantage plans include Part A and Part B benefits, so beneficiaries on this plan will have Part B coverage for spinal subluxation chiropractic treatment. In addition, some Medicare Advantage plans may also cover other chiropractic treatments like acupuncture, but this will depend on the provider and plan type.
Medigap: Medigap does not offer additional coverage other than what is offered by your Medicare Part A and Part B benefits. However, if you have a Medicare Supplement plan or Medigap, you can use it to cover your Part D deductibles and copayments for chiropractic care. Only beneficiaries on Original Medicare can purchase a Medigap plan to help cover out-of-pocket costs.
Requirements for Medicare Part B chiropractic coverage
Medicare Part B benefits cover outpatient medical care and services, including specific types of chiropractic care. Your part B benefits will only cover chiropractic treatment if it meets the following criteria:
· It must be deemed medically necessary by a qualified physician;
· It must be a treatment for spinal subluxation;
· It must be provided by a Medicare-approved chiropractor or provider.
Medicare Part B will cover up to 80% of the cost of chiropractic care if it meets the above criteria, so you will be responsible for 20% of the cost. Check to ensure that your chiropractor accepts Medicare before treatment since Medicare only covers chiropractic care from qualified and Medicare-approved providers. You can use the Medicare provider lookup tool.
To make sure that your chiropractic treatment meets the requirements for coverage, it is important to be aware of the treatments that are excluded. Medicare Part B chiropractic coverage exclusions include:
· Massage therapy, ultrasound treatments, or traction therapy;
· Chiropractic adjustments not related to spinal subluxation;
· X-rays or diagnostic tests.
How many chiropractic visits does Medicare allow?
There is no limit to the number of chiropractic visits that Medicare will cover, provided they are deemed medically necessary for the treatment of spinal subluxation. Provided your doctor deems that you still require chiropractic care, you can continue to receive treatment until your doctor recommends otherwise.
For beneficiaries on Medicare Advantage, coverage for spinal subluxation will be provided under your part B benefits. However, any limits that may apply to any other covered chiropractic services will depend on your Medicare Advantage plan limits and applicable conditions.
Other back pain treatments covered by Medicare
Apart from chiropractic care, your Medicare plan may also cover other treatments for back pain, including:
Acupuncture
If you have been diagnosed with chronic low back pain, Medicare will cover acupuncture treatments. Under Part B benefits Medicare will cover acupuncture only when it is used to treat chronic lower back pain.
Medicare Part B coverage for acupuncture is limited to 12 visits in 90 days. You may also get an additional eight visits if your condition shows signs of improvement. Note that you will be responsible for 20% of the costs.
If you have a Medicare Advantage plan, you may get extended coverage for acupuncture treatments, but this will depend on your specific plan and provider.
Physical therapy
If you have back pain, your doctor may prescribe physical therapy to help treat your condition. In such a case, Medicare will cover the cost of your physical therapy and your Medicare Part B benefits.
There is no limit to the number of physical therapy visits that your Medicare Plan B benefits will cover, provided the treatments are deemed medically necessary by your doctor. However, keep in mind that you will be responsible for 20% of the costs of treatment.
Medicare Advantage plans may also offer coverage for different types of physical therapy. If you have a Medicare Advantage plan, check with your individual provider for plan benefits and coverages for physical therapy services.
The best way to determine if your current Medicare Advantage or Medicare Part C plan covers any of the above benefits is to contact your plan directly and ask. However, if you are looking for a Medicare Advantage plan (Part C plan) that may help pay for these benefits, you can use an online Medicare plan finder such as Hella Health. This type of portal allows you to screen for plans that meet your needs without having to give your phone number to have someone call you; you can search for yourself, including screening for those that include Medicare Extra Benefits such as acupuncture.
Questions about Medicare?
Shoot us an email at medicare@hihella.com.
