You may have heard about — or even experienced — the difference that chiropractic care can make when your spine is misaligned. However, once you switch to Medicare, it’s common to wonder “Does Medicare cover chiropractic care?”
This guide will help you understand whether chiropractic care is covered under Medicare, and what the differences might be if you have Medicare Advantage. Then you’ll be able to approach chiropractic treatment with confidence.
Let’s get started!
Medicare will pay their portion of the Medicare-approved amount for your chiropractor visit. Your coverage will only apply if your chiropractor accepts Medicare coverage. If they do not accept it, you will not be able to use Medicare for your care.
Do you have Medicare Advantage? The coverage you receive might be different. While Medicare Advantage plans have to cover at least as much as Original Medicare, there might be additional benefits. That means x-rays or other therapies may have some coverage. However, your chiropractor will need to be within the insurance company’s provider network.
Are chiropractors covered by Medicare? Yes, they are. If you have Original Medicare, then Medicare Part B (for medical services) will cover manual manipulation of the spine by a chiropractor if it’s medically necessary.
Keep in mind that Medicare does not cover other services or tests from a chiropractic office. For example, a chiropractor will often order an x-ray for a new patient or may prescribe alternative therapy like acupuncture. These services are not covered by Medicare.
When did Medicare start covering chiropractic care? The answer might surprise you. Chiropractic care has been covered under Medicare since 1972.
If you have Original Medicare, you’ll first need to cover your deductible. If you have already paid your deductible earlier in the coverage period, for example for a different doctor's appointment or medical equipment, then you only need to pay your usual coinsurance.
In Original Medicare, your coinsurance is 20% of the Medicare-approved amount for care. Medicare pays the other 80%.
If you have Medicare Advantage, your costs could be different. You may have a specific copayment for chiropractic visits that you have to pay. You might also have a different deductible that needs to be met as well.
Original Medicare does not have a limit on chiropractic treatment as long as it is medically necessary. That means chiropractic care is needed to treat an illness, injury, condition, disease, or symptoms that meet accepted medical standards.
Your chiropractor can help certify if your treatment is medically necessary, and will provide documentation to Medicare to show your progress and ongoing needs.
If you have Medicare Advantage, the plan may have different standards. For example, they may have a limit on how often you can get coverage for chiropractic care in a 12-month period. Or, they might require certification of a specific treatment plan. Be sure you check with your Advantage plan to see what coverage limits might apply.
Original Medicare does not require a referral to see a chiropractor. However, the chiropractor must accept Medicare coverage in order for you to be able to use your insurance there.
A Medicare Advantage plan might require a referral, however. Sometimes referrals are only required for non-routine care. Be sure you understand the requirements of your coverage before you attend your first chiropractor appointment. Also, you’ll want to ensure you find a chiropractor that’s within your Medicare Advantage network.
This guide has answered the common questions we receive about Medicare and chiropractic care, but you might still have questions about your specific situation. Talking to a licensed insurance agent can help you better understand your coverage and your options. Contact us for more information today!
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