If you’ve recently joined Medicare or have private Medicare cover and want to go to the chiropractor, you’re probably wondering if your treatments will be covered.
While Medicare is an affordable way of reducing your medical bills, it won’t cover all types of treatments or services. There are also specific conditions that you have to meet for chiropractic before you can get Medicare coverage for it.
This guide will cover what kind of conditions Medicare covers for chiropractic services, what you need to do to be covered for chiropractic, how much you can claim, and other important information about Medicare and chiropractic services.
Medicare is a federal health plan for people over the age of 65, those with disabilities, and individuals that suffer from ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s Disease).
The program is divided into three parts that look at different types of medical expenses:
Medicare Part A is coverage for inpatient or hospital services, tests, and items that Medicare beneficiaries use.
Medicare Part B covers outpatient or non-hospital services tests and items.
Medicare Part D covers prescription drugs and medication that Medicare beneficiaries use for chronic conditions such as pain, diabetes, heart disease, and cholesterol.
When you join Medicare, there are a few options that you can use to get coverage for the Part A, B, and D expenses that we’ve mentioned.
Join Original Medicare: This government-run plan provides coverage for Medicare Part A and Medicare Part B expenses.
Join a Medicare Advantage plan: These are private Medicare plans that cover Part A, B and D expenses.
Join a Medicare Supplement Plan: If you have Original Medicare, you can join one of nine standardized Medicare Supplement Insurance plans that cover the additional costs of Medicare.
Join a Part D plan: People on Original Medicare can also join a standalone Part D drug plan, which covers the cost of chronic or ongoing prescription medication.
If you are eligible (turning 65, or have been diagnosed with ESRD or ALS) in 2022, you’ll have to pay a deductible cost on all Medicare plans before your expenses are covered.
Chiropractic coverage depends on your insurance company, but most plans cover chiropractic care nowadays. If you want to find out if your insurance will pay for chiropractic treatments, follow these steps:
Look at your policy plan, and check to see if they mention chiropractic services or treatments.
Call your insurance company and ask them if you are covered.
Speak to your chiropractor and ask them which insurance companies cover them.
If you’re looking for Medicare Advantage plans or Medicare Supplement Insurance plans that cover chiropractic procedures, speak to PolicyScout about finding a great provider in your area.
Original Medicare will only cover chiropractic for the manual manipulation of the spine, and the treatment must be:
Medically necessary: This means that a doctor has decided that service, treatment, or test must be done to treat the symptoms of injury, disease, or disability.
Recommended in writing by your physician: Medicare will only accept recommendations from your primary care physician or a directly referred specialist when deciding to cover chiropractic.
It’s essential to check with your medical provider before you go for chiropractic treatment to avoid unexpected bills.
Chiropractic can help with a variety of conditions, including:
The cost of chiropractic services will depend on a few things and can cost you anywhere between $30 and a few hundred dollars.
If you’re a Medicare beneficiary, here are a few steps you can take to find out how much you will have to pay for their services, and whether you’ll be covered by Medicare.
Firstly, check if the chiropractor you want to go to is registered with Medicare. By law Medicare-enrolled health practitioners, including chiropractors, cannot charge Medicare beneficiaries more than 15% over and above the Medicare-approved rate.
Secondly, if you have Medicare Advantage, contact your insurance company and ask if there are in-network chiropractors that you can visit.
Some chiropractors are contracted into HMOs or PPOs, and you might be able to see them for free or at least get a reduced rate.
HMOs (Health Maintenance Organizations) are health plans that offer health coverage through a network of health care providers such as physicians, specialists, chiropractors, and physical therapists.
With HMOs, members are only covered by their plan if they use doctors or medical professionals that are registered on their HMO. If they use a professional outside of their HMO network, their health plan won’t cover them.
PPOs (Preferred Provider Organizations) are health plans that work in a similar way to HMOs, except that they allow their members to see medical professionals in and out of their network.
For example, a person on a PPO might pay nothing to see a chiropractor that is on their plan’s PPO list. They can also visit a chiropractor that isn’t on their plan’s PPO list and their insurance will cover a portion of the costs.
Thirdly, if your chiropractor charges over the Medicare rate, phone around and get multiple quotes for chiropractic services in your area. You might be able to find a more affordable practitioner.
If Medicare covers your chiropractic treatment, you will still have to pay coinsurance and a deductible for the Medicare-approved amount.
Once you’ve done this, a portion of the costs will be covered by the health scheme.
Coinsurance: This is a portion of the costs you will have to pay after receiving treatment. For example, you will have a 20% coinsurance amount on outpatient expenses.
Deductibles: These are annual or per-use costs that Medicare beneficiaries must pay before Medicare cover starts.
For example, if you would like to be covered by Medicare Part B, you’ll need to pay the $230 deductible before Medicare covers 80% of your medical costs.
Medicare-approved amounts: Medicare places limits on the amount of money they pay for treatments, services, tests, and items. Any amount a medical practitioner charges over the Medicare-accepted rate is known as an excess charge and will not be covered by Medicare.
If a Medicare beneficiary is hospitalized and requires chiropractic or manual manipulation for an injury they will be able to see a chiropractor, and their costs will be paid by Medicare Part A.
First they will have to cover their Medicare Part A deductible, which is $1,556 in 2022. They will then be covered for the first 60 days of hospitalization and Medicare will cover their hospital costs, including chiropractic treatments.
Let’s say a person gets a letter of recommendation for chiropractic treatment and visits a chiropractor to treat their subluxation. The chiropractor might charge $120 for the appointment.
In this case, they will first have to cover their Part B deductible ($233 in 2022). Once they’ve done this, Medicare Part B will cover 80% of the cost ($96), and the patient will have to pay the difference of $24 (20%).
Subluxation is when a spinal bone or bones move out of place. Subluxation is said to cause several medical issues, including:
Check with your Medicare Advantage agent to determine if your plan covers chiropractic treatment. In some cases you might be fully covered for all treatments, or your plan might only cover specific chiropractic procedures.
Keep in mind that your healthcare insurance provider might require:
That you get a recommendation from a physician before you are covered
Proof that the treatment is medically necessary
That you visit an in-network qualified provider
Always contact your Medicare Advantage plan provider before you go for chiropractic care, treatment or follow-up visit.
Depending on the type of injury or back problem, Medicare might cover durable medical equipment, prescription pain medication, and long-term rehabilitation.
Our advice is to speak with your examining physician to work out what your treatment options are if you'd like your medical expenses to be covered by Medicare.
If you want to learn more about Medicare and what it covers, be sure to check out our Medicare Hub. We have the latest articles on Original Medicare, Medicare Advantage plans, Medicare Supplement Insurance, enrollment, and costs.
If you’d like to discuss Medicare with one of our agents, reach out at 1-888-912-2132 or firstname.lastname@example.org to speak with a Medicare professional about your coverage options.