If you suffer from chronic muscular or skeletal pain in your back, neck, or joints, you might have considered chiropractic treatment or adjustments. Chiropractic care is typically most effective when received at regular intervals. This can get expensive if you’re retired and living on fixed income. Sometimes chiropractic care is covered by private insurance plans. But if you’re aged 65 or older, you might wonder if you can obtain coverage through Medicare.
According to the US government’s Medicare website, Medicare Part B covers manipulation of the spine “if medically necessary to correct a subluxation.” A subluxation is when one or more of your spinal bones move out of position. Medicare defines the phrase “medically necessary” as “services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” In a nutshell, this means that if chiropractic treatment has been recommended for you by a licensed medical doctor, Medicare Part B will cover a portion of the payments.
However, there is a catch in terms of how much Medicare pays, so be sure to consult with your doctor or your chiropractic specialist before you receive treatment. First you’ll need to determine if your specialist accepts Medicare. If he or she does, then you’ll need to find out the Medicare-approved amount that your doctor or specialist will be paid. You will pay 20% of this number, and your Medicare Part B plan will pay the remaining 80%. Additionally, the Part B deductible applies, so this should factor into your cost calculations. If your chiropractic specialist suggests other services or tests beyond spinal manipulation, you will have to pay for those out of pocket. Examples of other services include physical or diagnostic exams, X-rays, massage therapy, physical therapy, nutritional supplements, and orthopedic devices.
Limits to coverage
Additionally, Medicare Part B limits chiropractic visits to one per day. You could receive more if your doctor determines that more frequent visits are necessary. Since chiropractic treatments are typically ongoing, Medicare coverage usually lasts as long as your doctor or specialist can document improvements in your condition. If your treatment program reaches a point where your specialist can no longer document improvement, Medicare coverage will end.
Aside from Medicare Part B coverage, there are also Medicare Part C plans (also called Medicare Advantage in some cases) that may offer chiropractic coverage. Part C plans are basically customized coverage options issued by third-party insurance companies. The costs and content of each policy vary widely. For example, United Healthcare offers a Medicare Advantage plan that includes x-rays and physical examinations, unlike the standard coverage found in the Medicare Part B plan. You should consult with your local insurance provider to see if a Medicare Advantage plan is right for you.
Additionally, you may choose to go with a private Medigap plan. Medigap is similar to a Part C plan in that it is customized by a third-party insurance provider to “fill in the gaps” in traditional Medicare Part A and Part B coverage.