Millions of Americans deal with back and neck pain, making chiropractic care an appealing option. This non-invasive treatment helps restore mobility and reduce discomfort without surgery. However, whether Medicaid or Medicare covers these services depends on your specific plan and circumstances.
Does Medicare cover chiropractic services?
Medicare provides partial coverage for chiropractic care, but it is limited to medically necessary treatments. Here’s how the different parts of Medicare address chiropractic needs:
Medicare Part A: Limited or No Coverage
Medicare Part A (hospital insurance) focuses on inpatient and hospital-related care. Chiropractic services, typically provided in outpatient settings, are not covered under Part A.
Medicare Part B: Specific Conditions Apply
Medicare Part B covers spinal manipulation only if it is deemed medically necessary to correct a subluxation (misaligned spine). This coverage excludes treatments for general back pain, massage therapy, and acupuncture, except when acupuncture is used for chronic lower back pain. Even for eligible treatments, Medicare beneficiaries are responsible for deductibles and 20% of service costs, with supplemental Medigap insurance potentially lowering these expenses.
Medicare Advantage plans (Part C)
Medicare Advantage (Part C) offers the same coverage as Part B, with additional benefits. Some plans may cover X-rays, diagnostic imaging, or other therapies. However, these benefits vary, so it is important to confirm coverage with your plan provider.
Eligibility for Medicare coverage
For chiropractic care to qualify under Medicare:
- Medically necessary treatment: The chiropractor must diagnose a subluxation requiring spinal manipulation.
- Approved provider: The chiropractor must be enrolled in Medicare.
- Documentation: A doctor’s recommendation or evaluation may be needed to establish medical necessity.
Does Medicaid cover chiropractic services?
Medicaid coverage varies by state. While some states include chiropractic services as part of their benefits, others do not. Medicaid is designed for low-income individuals and families, and states can set their own rules for optional benefits like chiropractic care. Confirm with your state’s Medicaid office for details on eligibility and coverage.
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Services Medicare and Medicaid typically exclude
Both programs have limitations. Medicare does not cover:
- General pain management is not linked to a diagnosed subluxation.
- Massage therapy.
- Routine X-rays are ordered by chiropractors.
- Most maintenance therapies are designed for overall wellness.
Similarly, Medicaid’s exclusions depend on state rules, but maintenance care and non-essential therapies are commonly excluded.
How much does Medicare pay for a chiropractic adjustment?
If you have Medicare Part B, you’ll pay 20% of the cost of a chiropractic adjustment at a facility that accepts Medicare. This can be reduced to $0 if you have Medicare Supplement Insurance (also called Medigap) in addition to Medicare Part B
How to verify coverage
Before seeking chiropractic care, verify coverage by:
- Check with your insurance provider (Medicare or Medicaid).
- Consult your chiropractor to confirm they are enrolled in Medicare or Medicaid and their services qualify for reimbursement.
- Reviewing your plan’s specific terms to avoid unexpected costs
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