Millions of Americans suffer from back and neck pain. In fact, around 80% of people in the U.S. experience back pain at some point in their lives. Not only is it uncomfortable, it can affect your work, disrupt your sleep and decrease your overall quality of life. Chiropractic care can help ease the pain and restore movement in the affected areas without surgery. Understanding what Medicare does and doesn’t cover is important to improving your overall back health.
Original Medicare has limited coverage for chiropractic care. In general, treatments for basic back pain aren’t covered. For example, muscle-related pain that is caused by strain, poor posture or overuse will most likely not be included in your Medicare benefits.
Let’s take a look at what parts of Medicare pay for different kinds of chiropractic services:
- Medicare Part A (hospital insurance) only pays for emergency procedures and hospital care. So chiropractors, who typically work in private offices or clinics, will not be covered.
- Medicare Part B (medical insurance) will cover spinal manipulation that is needed to correct a subluxation. This occurs when one or more of the bones in your spine are out of place. In some cases, acupuncture to treat chronic lower back pain may be included in your Part B coverage. It will also cover physical therapy (not massage therapy) that a doctor recommends.
- Medicare Advantage (Part C) may help pay for the cost of additional services that are not a part of your Part B coverage. This includes X-rays and other non-surgical therapies.
Conditions Eligible for Medicare Coverage
Medicare Part B will only pay for chiropractic care that is considered medically necessary. The treatment must not be considered ‘maintenance therapy,’ which can improve overall health and quality of life, but is not necessary to correct a misalignment.
In order to be covered, the following conditions need apply:
- A chiropractor must diagnose bone misalignment in your spine (also called subluxation) that requires treatment.
- Manual manipulation of the spine must be necessary to correct the spinal misalignment.
- The chiropractor providing the treatment must be enrolled in Medicare.
If you’re still unsure, check with your chiropractor to confirm the recommended treatment is covered. Otherwise, you may be surprised with out-of-pocket costs you’ll need to pay.
Conditions and Treatments Medicare Doesn’t Cover
Generally speaking, Medicare coverage for chiropractic care is very limited. Treatment for general back or neck pain (that comes from overuse or strain) are not included in your benefits. And Medicare will not pay for many services or tests a chiropractor may order, including:
- Massage therapy
- Acupuncture (unless used to treat chronic lower back pain)
Associated Services Medicare Covers
Currently, only services to correct a spinal misalignment are covered by Medicare Part B. Typically, that includes the initial exam, diagnosis and manual adjustment of the spine. Acupuncture and physical therapy for chronic back pain may also be covered if your doctor orders it. Additional services, including X-rays, will fall under your Medicare Advantage benefits.
Back pain doesn’t have to control your life. Treatment options are available to help you regain your movement and improve your overall quality of life. Take care of your back and it will take care of you. Want to know more about how a Wellcare Medicare Advantage plan can help? Contact us today.
Chiropractic Care Medicare Coverage Questions
How many chiropractic visits does Medicare cover in a year?
There is no limit on the number of chiropractic adjustments that Medicare will cover, but each appointment must be medically necessary to treat an altered vertebrae position.
How much does Medicare pay for a chiropractic adjustment?
If you have Medicare Part B, you'll pay 20% of the cost of a chiropractic adjustment at a facility that accepts Medicare. This can be reduced to $0 if you have Medicare Supplement Insurance (also called Medigap) in addition to Medicare Part B.
Does Medicare cover chiropractic care in my state?
Medicare covers chiropractic care across all states as long as the services are medically necessary. Specific coverage might vary slightly based on state regulations and individual circumstances. So, you should always check with your chiropractor to confirm coverage and possible out-of-pocket costs that may apply.
Which Medicare Advantage Plan is right for you?
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