If you have Medicare, chiropractor visits are covered if you require treatment to fix what is know as a subluxation (bone out of place) 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.
Dr. Alexander C. Frank and Florida Functional Neurology Group are Par Providers with Medicare Part B. If you are experiencing pain you believe results from a problem with your neck or back, including frequent headaches or migraines, it may be a sign of spinal subluxation. Seek the advice of a chiropractor.
Does Medicare Cover Chiropractor Visits?
Original Medicare (or Medicare Part B, Red/White/Blue card) 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.
Dr. Frank may require advanced studies such as X-rays, MRI, or VNGs (for cervical-induced dizziness, etc.) to diagnose issues with the spine in order to develop a treatment plans specific to YOUR needs. It is important to note that Medicare will not cover the costs of these tests, even if deemed medically necessary by Dr. Frank’s examination findings. Only medical physicians (i.e., MD, DO, ARNP, PA) can order advanced imaging/testing that Medicare may cover. 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.
Medicare Part C
Medicare Part C, or Medicare Advantage Plans, may provide more coverage for chiropractic treatment, as private insurance companies offer the plans. To see if Part C Medicare chiropractic treatment is covered, contact your insurance company and inquire about the benefits of your plan. Medicare Part C may offer more treatment options than Original Medicare, and may cover more of the cost. Some Medicare Part C plans cover not only your entire deductible, but also your 20% co-pay.
Your Financial Responsibility
Your financial responsibility regarding chiropractic payments will depend on your Medicare plan. Generally, Original Medicare covers 80% of the approved rate for office visits. You are responsible for paying your deductible and the remaining 20% (as of 10/2021 it was less than $8.00). With Medicare Part C, your insurance company determines your co-pays. Chiropractic care is typically considered a specialist visit, and that co-pay amount may apply.
For How Long Does Medicare Cover Chiropractor Visits?
A main concern among patients is that Medicare will cover some chiropractic visits, but not all. There is no limit on the number of chiropractic treatments you may receive, as long as you cover your deductible, continue paying the 20% fee, and a provider deems the treatment medically necessary.
Chiropractic Services Not Covered by Medicare
If you have Original (Red, white, and blue card) Medicare, chiropractor visits for ancillary services are not covered. These services include exams, acupuncture, laser, decompression, massage therapy, physiotherapies, review of test results, etc, and other treatment options the plan deems”not medically necessary.”
Finding a Medicare Chiropractor
One of the most important things to note is that any healthcare provider that accepts Medicare must hold a special licensure that allows them to receive reimbursement from the plan. Not all chiropractors or offices have the necessary license. For this reason, it is important that you find a chiropractor that Medicare does cover.