Does Medicare cover chiropractic care?
Medicare will cover some of your chiropractic care. Medicare does handle chiropractic care differently from medical treatment. Here are some of the differences in Medicare coverage:
An exam is required.
An examination is required by Medicare to identify the presence of a subluxation. Medicare does not pay for the cost of the exam or any x-rays needed. You may also need other therapies in your care including muscle stimulation, traction, or other therapies. Medicare does not cover these. Medicare also doesn’t cover adjustments to your wrist, ankle, or other extremities.
Medicare only covers the cost of chiropractic adjustments that are, “Active Treatment”.
Active treatment means:
- Your adjustments must relate directly to a musculoskeletal complaint,
- Your adjustments must be making functional improvements within two weeks, and
- You must follow your chiropractor’s specific plan for active treatment.
Once improvement stops, Medicare coverage stops.
Medicare judges your progress by wanting to see improved function—not just how you feel. At this point, your case would be considered, “Maintenance Care.” Medicare does not pay for chiropractic care to maintain your progress or help prevent problems. You do have the option to opt to self-pay.
How much do I have to pay for chiropractic with Medicare?
Medicare requires you to pay your annual deductible amount. Once you pay that amount, you will be responsible for a 20% coinsurance on the cost of your active treatment adjustments. Everything else in the office will be your responsibility.
What if I have Medicare and a supplement or secondary plan?
We understand that you may have a supplement or secondary plan, they will pick up your 20% coinsurance on the adjustments. Since we are participating with Medicare, we will bill the claims and receive payment from them. Please understand your supplement or secondary will not pay for excluded services, so those will still be your responsibility.
