Does Medicare Cover Chiropractic Care?April 9, 2020
Many people visit the chiropractor to treat a variety of conditions including back pain and headaches. Chiropractic care may be an alternative to prescription drugs.
The idea is that chiropractic care will treat the root cause of the problem, rather than just treating the symptoms. If you have Medicare insurance, you may want to know, “Does Medicare cover chiropractic care?” Yes, but according to the official notice of Medicare coverage for chiropractic care, Medicare has non-covered, always-covered, and perhaps-covered categories.
So it is only applicable in limited circumstances when chiropractic care treatments meet specific rules.
Medicare Chiropractic Coverage
Medicare will not cover the X-rays, massage therapy, or acupuncture treatments your chiropractor may recommend. However, Medicare does cover chiropractic care (spinal manipulation) to correct subluxations, which describes the condition when one or more spinal vertebrae move out of position.
Original Medicare consists of hospital insurance (Part A) and medical insurance (Part B). Medicare Part B will help pay for chiropractic services if your doctor says they’re medically necessary.
If your chiropractor is Medicare-approved, Part B will pay for 80% of your adjustment. You will still owe 20% coinsurance, and the Part B deductible applies.
Original Medicare does not cover many services people want. Private insurance plans called Medicare Advantage (MA) plans can offer coverage for additional chiropractic services.
MA plans vary by location and carrier, and choosing a plan may seem overwhelming. A licensed agent with Medicare Plan Finder can help you find a health insurance plan in your area that fits your needs.
Here is how Medicare Part A, B, C, and D apply to Chiropractic coverage:
- Medicare Part A will not cover a visit to a chiropractor because it only applies to hospital care. Chiropractic care is classified as a non-emergency medical service provided in a chiropractic doctor’s office.
- Medicare Part B covers manipulation of the spine if a chiropractor believes treatment of a subluxation, which is a misalignment of the spine, to be medically necessary. Part B also provides coverage for physical therapy, since this is another outpatient treatment.
- Medicare Part C, the Medicare Advantage plan part, will also cover medically necessary chiropractic services.
- Medicare Part D, the Medicare prescription drug benefit, does not apply to chiropractic care at all because Chiropractors are not typically permitted to prescribe medicines legally.
How Many Chiropractic Treatments Does Medicare Cover?
Medicare provides five paid chiropractic visits annually. This can be arranged by your physician through either the Chronic Disease Management plan (CDM) or the Team Care Arrangement (TCA). Medicare chiropractic coverage will save you more than $250 in your healthcare costs.
How Much Does Chiropractic Care Cost With Medicare?
Medicare beneficiaries are United States residents enrolled in Medicare Part A or Part B benefits, or enrolled in both Part A and Part B. They are entitled to receive most medical services after paying their deductibles and a 20% coinsurance.
As a Medicare beneficiary, several factors affect the exact amount you pay with Medicare, for example:
- Your health insurance plan
- How much your chiropractor charges
- Whether your doctor takes Medicare and accepts the assignment
- The type of facility
- The location of your test or service
What Leads to the Need for Chiropractic Adjustments?
Many common conditions can lead to spinal subluxations. For example, let’s say you bend over to pick something up, and when you stand up, your back doesn’t feel right. It hurts, feels tight, and you can’t stand up straight.
You visit your doctor right away, and your doctor determines that your spine is out of alignment. Your doctor might refer you to a chiropractor.
Before your chiropractor creates a treatment plan you will have X-rays and tests to assess your range of motion.
Improper lifting is one cause of spinal subluxations. Other common causes include:
- A vertebra going out of place due to slips, trips or falls
- The entire spine slipping out of place because of poor posture
- Damage to intervertebral joints (joints between the vertebrae) resulting in joint swelling
- Osteoporosis or degenerative spine disease
- Tight back muscles that can move the vertebrae out of place
Why Good Posture Is Important
Many people sit down for 6-8 hours a day, and that sedentary lifestyle may be more dangerous than smoking. You may spend hours looking at your phone or laptop while hunched over. That puts unnecessary strain on your neck.
For every inch that your head strays from its natural position, you put an extra 20-30 pounds of pressure on your neck (according to Rene Cailliet, MD, former Director of the Department of Physical Medicine and Rehabilitation at the University of Southern California).
While you sit, don’t slouch. Sit with a straight back and keep your head squarely above your shoulders. If you sit for an extended period of time, be sure to get up and walk around for a while. Develop healthy habits such as stretching your entire body every day.
Benefits of Chiropractic Care for Seniors and Medicare Eligibles
Even though Medicare does not cover chiropractic care unless it’s part of subluxation correction, you may still benefit from chiropractic care. Along with correcting subluxations, chiropractic care may provide relief from headaches, low back and neck pain, and sciatica.
Many people may not want to take prescription drugs for headache relief, and they may want to pursue an approach that doesn’t require an abundance of OTC meds either. Many studies suggest that chiropractic care helps treat both tension and migraine headaches.
Lower Back Pain
Chiropractic treatment may be a cost-effective approach to successfully treating lower back pain. Some patients may find that spinal manipulation is more effective for providing pain relief in the long term.
If your doctor recommends chiropractic care for your lower back pain, then it may be a viable option for relieving pain symptoms.
Sciatica refers to a pinched sciatic nerve. It usually starts with a herniated spinal disk. The pain runs from the base of the spine into your legs, and it can range from a mild ache to severe pain.
Your foot might also go numb or feel weak. According to the European Spine Journal, chiropractic adjustments may be more effective than corticosteroid treatment for sciatica.
Common Chiropractic Care Questions
What chiropractic codes does Medicare cover?
Here are the most common chiropractic codes:
- CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
- CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
- CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
Does Medicare cover chiropractic care in 2020?
Medicare chiropractic coverage in 2020 continues to cover the Medicare guidelines for chiropractic documentation.
Where can I find the latest Medicare fee schedule for 2020?
Medicare.gov is where you will find all the information you need about Medicare’s chiropractic coverage, including the latest Medicare chiropractic fee schedule.
Does AARP United Healthcare cover chiropractic?
Most plans in the AARP secondary Medicare insurance offer a chiropractic benefit.
Let Us Help You Find Medicare Coverage for Chiropractic Care
If you’re one of the many people who rely on chiropractic care for pain relief, you may want to consider a Medicare Advantage plan to help cover costs.
The licensed agents at Medicare Plan Finder are highly trained and they can help you find a MA plan in your area with additional chiropractic coverage. Call 833-438-3676 or contact us here to learn more.
This post was originally published on June 24, 2019, and updated on April 9, 2020.