Medicare covers chiropractic procedures, but the criteria are extremely specific. Medicare will only cover chiropractic care as a treatment for a condition called spinal subluxation.
Chiropractic care is a treatment system that focuses on the alignment of your muscles and bones.
One of the most popular forms of chiropractic care is called “spinal manipulation,” sometimes referred to as chiropractic “adjustment.”
Medicare covers chiropractic procedures but only as a treatment for spinal subluxation.
For Medicare to cover this treatment, you’ll also need an official diagnosis and a qualified chiropractor. Some Medicare Advantage plans offer coverage for additional chiropractic care.
Medicare Part A
Medicare Part A does not cover visits to the chiropractor.
Medicare Part A deals with hospital care. Since chiropractic care is a service, not an emergency procedure, and it takes place in a doctor’s office, Medicare Part A does not cover it.
Medicare Part B
Medicare Part B covers medically necessary services (treatments required for your immediate needs) as well as preventive care. Preventive care is a little tricky to define, but mental health services, flu shots, and well visits to your general practitioner are all considered preventive care.
Medicare Part B will cover spinal manipulation (alignment) as a medically approved treatment for spinal subluxation.
The number of treatments covered may differ depending on how many treatments are necessary to correct your condition.
Medicare Part B will cover 80% of the cost of the treatment after you’ve met your yearly deductible. Medicare won’t cover the cost of diagnostic tests your chiropractor might order, such as X-rays.
For many years, bills have been introduced in the U.S. House of Representatives to expand the types of chiropractic care Medicare covers. The most recent bill is the Chiropractic Medicare Coverage Modernization Act of 2023 — H.R.1610 and S.799.
The bill has yet to pass, but if it passes, Medicare coverage for chiropractic services may be expanded.
Medicare Part C
Medicare Part C, which is also called “Medicare Advantage” or “MA,” is the name for Medicare health plans offered by private insurance companies.
These plans are approved by the federal government, but they might offer additional coverage for treatments that Part A and Part B don’t cover. These plans cover you as your primary insurance.
Some Medicare Part C plans may cover chiropractic treatment, but each individual plan will differ in what it offers.
Some plans may cover treatments beyond spinal manipulation. You can research exactly what individual plans cover, compare them, and purchase a Part C plan at the Medicare.gov website.
Medigap/Medicare supplement plans
Medigap plans, also called “Medicare Supplement Insurance,” are plans you can purchase in addition to Original Medicare. Copayments and deductibles are some of the things Medigap plans can pay for.
If you have Original Medicare and are approved for chiropractic treatments, you’re still responsible for 20% of the cost. If you’ve purchased a Medicare supplement plan, that plan would cover that cost.
You can compare and purchase Medigap coverage on the official Medicare website.
Tips for enrolling in Medicare if you need chiropractic care
- Know when the open enrollment period is: This is the time during which you can enroll in or make changes to your Medicare plan. Every year, open enrollment for Medicare Advantage plans is October 15 through December 7.
- Compare plans: The cost and coverage of Medicare Part C and Medigap can vary greatly. Be sure any plan you choose includes chiropractic care.
- Check on chiropractors: Some plans require that you use a provider in their network. Before enrolling, double-check to see if your chiropractor is approved and included in your plan’s network.
If you know that you need chiropractic care, remember that regular Medicare will only cover it as a treatment for spinal subluxation.
You’re 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 body’s musculoskeletal system back into proper alignment.
These treatments are usually administered in a chiropractor’s office, though some chiropractors have hospital privileges.
Chiropractors may also offer other health services, such as:
- nutritional advice
- acupuncture
- fall prevention
Roughly
Research into the effectiveness of chiropractic treatment is ongoing. Currently, there is no conclusive data set demonstrating outcomes.
However, there’s a significant body of
- sciatica
- low back pain
- headache
If you visit a chiropractor for chronic back pain treatments, Medicare may cover your visits.
Currently, manual manipulation of the spine for spinal subluxation is the only type of chiropractic treatment that Medicare covers.
Medicare Part B covers these services, but Medicare Advantage plans and Medigap can play a role in paying for these treatments, too.