A common question among Medicare recipients, is if Medicare can cover the cost of Chiropractic Services. The answer may vary, but typically, the answer is YES, in some situations, limited services are covered by Medicare.
According to the Medicare.gov website, “Medicare Part B” (Medical Insurance) covers manual manipulation of the spine if medically necessary to correct a Subluxation when provided by a chiropractor or other qualified provider.
However, Medicare also noted there is not Part B coverage for “other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture.” Medicare defines “Medically necessary” as: “Health care services or supplies needed to diagnose or treat and illness, injury, condition, or its symptoms and that meet accepted standards of medicine.”
As a reference, please feel free to see more here: https://www.medicare.gov/coverage/chiropractic-services
What will you pay for chiropractic services?
For approved chiropractic services, Medicare notes that you will “pay 20% of the Medicare-approved amount and the Part B Deductible applies.”
Medicare Advantage Plans and Chiropractic Coverage
Some Medicare Advantage plans provide additional chiropractic coverage. The chiropractic services may be offered from your Medicare Advantage plan as an addition package or “coverage bundle” for an additional cost. To learn more about your specific Medicare Advantage plan coverage, you can contact Member Services by using the toll-free number found on your Member ID card or you can review your plan’s Evidence of Coverage document where you can find such information such as “Chiropractic Services”.
Covered services include: Only manual manipulation of the spine to correct subluxation. Prior authorization may be required and is the responsibility of your provider.
What you must pay when you get these services in-network: $20 copay for each Medicare-covered Chiropractic visit.
What you must pay for out-of-network services: After you pay your $500 deductible, you pay 50% coinsurance for each Medicare-covered chiropractic visit.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- Whether your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
Medicaid and Chiropractic Coverage
Depending on where you live, state Medicaid programs also provide some level of chiropractic coverage. If you are eligible for Medicaid, you can contact or visit your local state Medicaid office for more information about chiropractic coverage.