Understanding Medicare Chiropractic Coverage
If you know that you need chiropractic care, remember that regular Medicare will only cover it as treatment for spinal subluxation.
Youre responsible for the cost of treatment until you meet your annual deductible.
Medicare Advantage plans and Medigap plans may help cover some of your out-of-pocket costs for chiropractic care. You cannot choose both, you must decide if you want an Advantage plan or Medigap coverage.
Chiropractic treatments focus on the connections between your bones and muscles. Licensed chiropractors perform movements that bring your bodys musculoskeletal system back into proper alignment.
These treatments are usually administered in a chiropractors office, though some chiropractors have hospital privileges.
Chiropractors may also offer other health services, such as:
- nutritional advice
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
- The location of your test or service
Does Medicare Cover Chiropractors The Bottom Line
While Medicare doesnt cover additional tests like x-rays, massage therapy, or acupuncture if they are ordered by a chiropractor, Medicare does cover the cost for the treatment of lower back pain by a chiropractor.
If you need additional testing, your chiropractor may be able to refer you to another doctor so that Medicare can cover the costs.
Now that youve learned about how Medicare covers a chiropractor, shop around for coverage. Enter your ZIP code into our free tool below and start comparing quotes in your area.
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How Might You Get Medicare Coverage For Chiropractic Services
One way you may be able to get additional Medicare chiropractic coverage is through a Medicare Advantage plan. Some Medicare Advantage plans could provide additional chiropractic coverage benefits. Check with your Medicare Advantage plan directly to see what chiropractic services are covered. You still need to continue paying your monthly Part B premium along with any premium the plan might charge.
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Chiropractor Prices Without Insurance
If your insurance plan doesn’t cover chiropractic care, or you have reached the end of your chiropractic benefits, you can always pay for your treatments out of pocket. There are a lot of factors that go into the price charged by individual chiropractic practices. Among the mot important is the location. Some states have a higher cost of living then others, and those will generally have higher testing and treatment costs. Living in an urban area is also a deciding factor. Rural practices are often less than the same services in an urban practice. At the low end, you may be charged around $50 for a treatment. At the high end, the fees may be about $200 per session.
No matter what your insurance covers, chiropractic care is an up-to-date, time-tested type of care that can help to alleviate problems like back pain, whether they are caused by a car accident, slip & fall, sports injury or other ailments. With a manual manipulation, you may find yourself feeling better than you have in a long time.
Chiropractic Care Can Help:
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Do Private Medicare Plans Cover Spinal Care
Medicare Advantage plans are sold by private insurers and are allowed to offer extra benefits not covered by Medicare Part A or Part B. These extra benefits typically include prescription drug coverage and may include additional coverage for chiropractic care, depending on the plan you have.
Medicare Part D plans provide coverage for prescription medications and may cover some drugs used to alleviate back pain. Medicare Part D does not, however, provide coverage for medical services.
Does Medicare Cover Chiropractic
Medicare provides health insurance for American citizens aged 65 and older, as well as those who have certain disabilities or illnesses. Services deemed medically necessary by a healthcare provider are usually covered by either Medicare Part A or Medicare Part B. In this post, we answer the question: Does Medicare cover chiropractic care?
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Does Medicare Cover Chiropractic Services
En español | Original Medicare pays for only one chiropractic service: manual manipulation of the spine if deemed medically necessary to correct a subluxation .
This procedure, when performed by a chiropractor or other qualified provider, is covered through Medicare Part B, the component of original Medicare that includes outpatient services.
Medicare will pay 80 percent of the Medicare-approved rate for this procedure. You will owe 20 percent of the amount. You must also pay your deductible for Part B before Medicare begins to pay its share.
You pay all the costs for other services provided or tests that a chiropractor orders, including acupuncture, massage therapy or X-rays. Medicare will cover the cost of an X-ray a physician orders to demonstrate that a spinal subluxation requires treatment but will not if a chiropractor ordered the X-ray.
Some Medicare Advantage plans offer routine chiropractic services as an additional benefit. Check with your plan provider about whats available.
Editor’s note: This article was originally published on July 15, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.
How Much Does A Chiropractic Visit Cost With Medicare
With Original Medicare, you will end up paying a 20% coinsurance for a chiropractic visit. Medicare Part B pays the other 80% of the Medicare-approved amount. The Part B deductible will apply as well.
Your costs may be different with a Medicare Advantage plan depending on your doctor and what type of treatment you may receive. A Medigap plan can also help cover these costs.
No matter what plan you choose, you will pay all costs for other services provided or tests that a chiropractor orders, including acupuncture, massage therapy, or X-rays.
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How Can Chiropractic Care Help Seniors With Back Pain
A common reason why elderly people go to a chiropractor is due to back, muscle, or bone pain. Some people go to a chiropractor for a single issue that can be resolved in one session, and others continue to see a chiropractor for ongoing problems.
Some ways that a chiropractor can help include:
- Providing pain relief by addressing subluxations in the spine that cause pain and inflammation without the use of pain medications.
- Assisting chronic conditions like COPD. Studies showed that seniors who had some type of chiropractic treatment over four weeks were less likely to have an adverse event.
- Reducing risk for falls by helping to lessen subluxations in the spine and to teach seniors about the benefits of exercise and stretching.
- Improving quality of life by helping with increased range of motion in extremities and reducing joint stiffness.
There are risks to consider such as soreness and risks of bone damage, injury, or stroke. This is why it is important to have a doctor sign off on chiropractic treatment before having it.
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 .
While you sit, dont 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.
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Does Medicare Cover Chiropractic Visits
If one or more of your spinal bones have moved out of position, you have a subluxation. Since July 1, 1973, Medicare Part B covers chiropractic visits to correct subluxation.2
Your chiropractor must satisfy Medicares licensure requirements and other conditions outlined in the Medicare Benefit Policy Manual for Medicare to cover chiropractic care.
Under Original Medicare or Medicare Advantage insurance plans , youll typically pay 20% of the Medicare-approved amount for treatment and your Part B deductible.
Medicare will pay the remaining 80% of your chiropractic treatments. Some Medicare Advantage plans may have different coinsurance and deductible requirements, so be sure to check with your plan carrier directly to confirm how much your chiropractic care will cost.
The exact amount youll pay depends on a variety of factors, including:
- The amount your chiropractor charges
- Whether the chiropractor accepts Medicare assignment, which means they accept Medicare reimbursement as payment in full for their services
- The type of facility your chiropractor works in
Your chiropractor or a customer service assistant at their practice should be able to estimate out-of-pocket costs for you before you receive any services.
What If I Am Already Seeing A Chiropractor
The same conditions apply regardless of whether you are currently seeing a chiropractor or have never been to the chiropractor before. Medicare will pay for up to 5 of your ongoing visits with your chiropractor following the referral from your GP.
If you are currently seeing a chiropractor the 5 visits that you are entitled to can be used during your ongoing treatment.
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Medicare For Chiropractic Care
If you have Medicare, chiropractor visits are covered if you require treatment to fix what is know as a subluxation of the spine. A spinal subluxation is a common chiropractic issue. It means that the vertebrae in your spine are not in proper position. Subluxation can cause back, neck, and shoulder pain, as well as joint problems, nerve problems, and muscle pain. It can result in increased inflammation, fibrosis, muscle atrophy, and more. However, the condition is easily treated by regular spinal adjustments. With Medicare, chiropractic treatment can be extremely beneficial in managing the pain that many patients experience.
ChiroCare of Florida accepts Medicare. If you are experiencing pain you believe results from a problem with your neck or back, including frequent headaches or migraines or digestive issues, it may be a sign of spinal subluxation. Seek the advice of a chiropractor. We accept Original Medicare, Medicare Part C, and Medigap Part F plans. Call us today at 977-216-6206. With eleven locations across South Florida and extended weekday hours, you can begin your chiropractic treatment plan today.
Which Services Are Covered Under The Medicare Chiropractic Benefit
Your chiropractor may offer many services, but Medicare only covers treatment for spinal subluxation to help manage back pain. Spinal subluxation is spinal manipulation, or what chiropractors simply refer to as adjustments..
Additional services or tests ordered by the chiropractor such as massage therapy, x-rays, or acupuncture may not be covered. Medicare does cover up to 20 sessions of acupuncture for people experiencing chronic back pain, but the eligibility guidelines are strict. If your visit to the chiropractor is to treat an issue other than back pain, Medicare may not cover the service.
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- While Medicare does cover chiropractic services, it does not cover any additional testing
- If you need additional testing, your chiropractor may be able to refer you to another doctor so that Medicare will cover the costs
- Some Medicare Advantage plans offer routine chiropractic services as an additional benefit
When looking to answer: does Medicare cover a chiropractor?, its important to remember that while it does, in most cases, some additional testing may not be included.
Medicare covers chiropractic manipulation of the spine to help people manage pain, provided they have active pain. However, it only pays for chiropractic care that corrects an existing problem.
What Chiropractic Codes Does Medicare Cover
Chiropractors use a range of Current Procedural Treatment codes when billing Medicare for patient services. Medicare covers the following chiropractic codes:
- CPT Code 98940: Chiropractic manipulative treatment of the spine in one to two regions
- CPT Code 98941: CMT of the spine in three to four regions
- CPT Code 98942: CMT of the spine in five regions
Chiropractors must also add the AT modifier code to CPT Code 98940, 98941, or 98942. This modifier shows the patient is receiving acute treatment. Without this modifier, Medicare assumes the patient is having maintenance treatment and denies the claim.
Does Medigap Cover Chiropractic Care
Medicare Supplement Insurance, more commonly known as Medigap, helps pay some of your out-of-pocket costs under Original Medicare.
If Medicare Part B covers the service, then Medigap Plans A, B, C, D, F, G, M, and N will cover 100 percent of the 20 percent coinsurance amount. Medigap Plan K covers 50 percent of your Part B coinsurance and Plan L covers 75 percent.
Use our Find a Plan tool to compare your Medigap and Medicare Advantage plan options. Just enter your location and coverage start date to begin reviewing Medicare plans in your area.
How Much Will You Pay For Chiropractic Care With Medicare Part B
After you meet your Medicare Part B deductible, you’ll pay 20% of the approved cost of chiropractic care. Medicare will pay the other 80% of the cost. You must go to a chiropractor that accepts Medicare for your bill to be covered, otherwise you risk paying the whole amount for the service.
The cost of your chiropractic bill is based on the number of spinal regions that need manipulation.
Average Medicare-approved amount
Remember to always seek out medical advice from a health care professional about what type of treatment is best for your needs.
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Does Medicare Cover Chiropractor Visits
Original Medicare does cover some chiropractic services, though not all. According to the Official U.S. Government Site for Medicare, the plan does cover spinal manipulation if a chiropractor deems it medically necessary. If you are experiencing back pain, it is likely that chiropractic treatment is the correct form of treatment and Medicare will cover the expense.
Often, chiropractors request X-rays to diagnose issues with the spine. It is important to note that Medicare will not cover these costs unless a physician orders the test. If a chiropractor orders the X-ray, Medicare will not cover the cost. Be aware before your visit that Medicare does not require an X-ray to prove you require treatment for a spinal subluxation. You can still receive covered Medicare chiropractor visits without one.
Should Medicare Step Up And Pay For Chiropractic Care
According to the American Chiropractic Association, new research in the Spine journal has shown that chiropractic care improved the overall health or well-being of individuals with back and neck pain.
One study even showed that regular medical patients saw their pain get worse, while chiropractic patients reported that their pain was better or much better:
âPatients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.â
Dr. William Charschan from Charschan Chiropractic in New Jersey says that the current Medicare coverage is a disincentive for patients to see chiropractors at all. This can be extremely frustrating for doctors, especially when they have a unique way of actually curing patients.
âMany patients visit after fully-covered services, such as physical therapy, have failed to deliver the desired results, and some do not want to take medication,â Dr. Charschan explains.
This leaves us all quite confused â if Medicareâs goal is to help Americans be healthy, why would they refuse to pay for most chiropractic care given this research?
Dr. Godfrey’s Chiropractic Office
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What Happens On Your First Visit
During your first visit we will do a thorough history and examination of your spine and, if necessary, arrange any x-rays that are needed to find the cause of your problems. These x-rays are fully covered by Medicare so you will have no out of pocket expenses.
How Do You Change Your Medicare Plan For Better Chiropractic Coverage
If you have Original Medicare, your chiropractic coverage is limited, and you incur a 20% coinsurance when you get Medicare-covered chiropractic care. You can either:
- Switch to a Medicare Advantage Plan that has more chiropractic coverage beyond what Medicare will cover. Some plans offer supplemental benefits for routine or maintenance chiropractic care. You may pay a higher monthly premium and copays or coinsurance for the supplemental benefits depending on the plan. OR
- Purchase a Medigap plan to help cover the coinsurance payments if you can find an insurance carrier in your state that will sell you a plan. If you missed your opportunity to purchase a Medigap plan during your Initial Enrollment Period or your Medigap open enrollment period, you might need to go through the process of medical underwriting and may pay more to get a plan.
You can change your Medicare Plan for better chiropractic coverage during specific enrollment periods:
- Annual Open Enrollment if you already have Medicare Part A and B. You can join a Medicare Advantage Plan that offers supplemental coverage for chiropractic care. Your new plan will take effect on January 1 the following year.
- Annual Medicare Advantage Open Enrollment if you want to switch from your current Advantage plan that doesnt offer supplemental coverage for chiropractic to one that does. Your new plan will take effect the month after you make the switch.a physician orders them