If you are one of the 25% of Americans who recently sought medical treatment for neck or lower back pain, you may be wondering if your Medicare Supplement Insurance policy covers these services. This depends almost entirely on whether or not the recommended treatments are covered by Original Medicare, which has very strict rules about what chiropractic care is acceptable.
Chiropractic care is a non-drug based approach that is often recommended as to help reduce back and neck pain. Original Medicare will only cover up to 80% of your chiropractic visits if the following conditions are met:
- You have paid your annual part B deductible
- The chiropractor you choose is Medicare certified
- You are diagnosed with a spinal subluxation
A “spinal subluxation” happens when one or more of the bones of your spine is out of alignment. Symptoms may include pain, muscle stiffness, numbness, mobility limitations and headaches. This condition can be acute—when caused by a fall or accident—or chronic and developed over several years. Chiropractic care uses manual manipulation—commonly referred to as a “spinal adjustment”—to attempt to better align the spine and improve symptoms.
If you meet the above conditions, after Medicare has paid its part a Medicare Supplemental Insurance plan will help you cover the remaining balance. Most Medicare Supplemental Insurance plans fully cover the 20% of chiropractic visits not covered by Original Medicare. The exceptions to this rule are Plans K and L which cover 50% and 75% of these coinsurance amounts respectively.
It’s important to be aware that many chiropractors are considered “non-participating Medicare providers,” which means they accept Medicare patients, but may charge up to 15% more than Medicare allowable amounts for the services. If you choose one of these providers, the care will still be covered if you have a Medicare Supplement Policy, but only plans F and G will cover the excess charges.
Unfortunately, Original Medicare will not cover the x-rays your chiropractor may recommend to help diagnose your condition. Medicare will cover x-rays ordered by your primary care physician or orthopedic doctor, so you may be able to get the x-rays you need this way. Original Medicare will also not cover some types of possible recommended follow-up care, such as massage therapy or acupuncture. Original Medicare does not have an annual limit on chiropractic adjustment visits and you are allowed as many as medically necessary to correct the condition. Some Medicare Supplement policies will cover additional screenings, not included in Original Medicare. When in doubt about what’s covered check your plan documents or call your plan directly before receiving services.
- Original Medicare ONLY covers chiropractic care if the diagnosis is spinal subluxation.
- X-rays, massage therapy, acupuncture and other alternative care your chiropractor may recommend are NOT covered.
- Most Medicare Supplement plans will fully cover the 20% of chiropractic care costs not covered by Original Medicare. Plans K and L will pay a percentage.
- To reduce risk of unexpected out-of-pocket expenses, ask the chiropractor if they accept Medicare before receiving treatment.