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Written byTaylor Milam-Samuel
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8+ years writing for major outlets, including MarketWatch and Business Insider
Master’s in Education
Taylor Mlam-Samuel is a personal finance writer and credentialed educator. When she’s not helping readers better save and spend money, she can be found teaching.
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Edited byChris Schafer
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15+ years in content creation
7+ years in business and financial services content
Chris is a seasoned writer/editor with past experience across myriad industries, including insurance, SAS, finance, Medicare, logistics, marketing/advertising, and many more.
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Updated July 18, 2024
Reading time: 4 minutes
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Table of contents
Table of contents
Original Medicare includes coverage for chiropractic visits but only for one type of treatment. Patients with subluxation of the spine are eligible for manual manipulation. You must have proof, from an X-ray or physical exam, that treatment is necessary.[1]
Medicare Part B will cover 80% of the cost of treatment after you meet your annual deductible.[2] You can also opt for a Medicare Advantage plan (Medicare Part C), which is a Medicare plan available from a private insurer. Medicare Advantage plans might include additional coverage for chiropractic care, but it varies from one insurer to the next.
Here’s how to determine how much chiropractic treatment your Medicare plan covers.
Eligibility criteria for chiropractic coverage
Original Medicare includes Medicare Part A and Part B. Part B covers medically necessary and preventative services. The plan covers some chiropractic care when it’s a medical necessity, but it’s limited to active treatment for chiropractic spinal manipulation.
Treatment can’t be indefinite. Your doctor’s assessment of a reasonable expectation for recovery or improvement from treatment will determine the number of covered visits.
Medicare Part B only covers active or corrective treatment for subluxation, which is the misalignment of vertebrae. Subluxation can be caused by aging, injuries, or specific health conditions. For example, patients with scoliosis often have subluxation.
Important Information
You must have recent proof of subluxation to receive care since Medicare Part B doesn’t cover maintenance therapy or preventative care. To qualify for treatment from a chiropractor, Original Medicare patients must have documentation from a doctor to prove that there’s a misalignment. This documentation can come in the form of X-ray results or a physical exam.
Specifics of chiropractic coverage
Medicare Part B only covers manual manipulation of the spine, a hands-on treatment involving movement and pressure on the spine to increase functionality. Some chiropractors also offer additional services like acupuncture, physical therapy, and massage therapy, but Medicare Part B doesn’t cover those treatments.
Your Medicare health insurance will often cover the cost of diagnostic treatment to determine the condition, but a doctor must order the X-ray or perform the exam. Medicare doesn’t cover diagnostic tests or exams from a chiropractor.
The X-ray documentation must:
Include a specific subluxation level
Be from the last 12 months or within three months of starting treatment
Patients with chronic conditions can use an older X-ray, MRI, or CT scan.
The physical exam documentation must include the following:
Documentation of pain, misalignment, range of motion abnormality, or tone change
Information about the history of the condition, including family history or past health history
Patents must have documentation to access chiropractic services through Medicare Part B. It might sound like a complicated process, but you can start by scheduling a visit with your doctor and explaining your pain or areas of concern. In most cases, the documentation process occurs naturally as part of the diagnosis.
Medicare limitations on chiropractic visits
Medicare doesn’t mandate a maximum number of chiropractic visits, but you must require active treatment. Active treatment aims to correct acute or chronic subluxation. Doctors usually classify new injuries as acute subluxation. So if your pain is recent or due to an injury, it’s likely acute, and Medicare Part B would cover treatment.
When your pain is due to a long-term health condition that’s not likely to resolve, doctors consider it chronic. Chronic conditions can qualify for chiropractic coverage under Medicare Part B if doctors expect treatment to result in functional improvements. But once your condition is stable, you might lose coverage for chiropractic services if the provider doesn’t expect further improvement.
Good to Know
Medicare coverage pays for treatment if it can improve your current condition or quality of life. If you want to visit the chiropractor to prevent injuries or address an ache, you must pay out of pocket.
Cost considerations for chiropractic visits
Before coverage kicks in, you must meet your Part B annual deductible of $240. After your deductible, Medicare covers 80% of the cost of a visit, and you’re responsible for 20%.[3]
The cost of a chiropractic visit depends on the treatment you need, the doctor, the hospital, and other factors. You can contact your healthcare provider to get an estimate. Once you know the total price, you can calculate your copay.
Whether or not you have supplemental Medigap insurance also affects how much you’ll pay for treatment.
Effect of supplementary insurance
Supplemental Medigap insurance can reduce your cost of chiropractic care. Some plans — like Plan G, Plan M, and Plan N — cover the Part B copayment, which means you won’t have to cover 20% of the cost of a chiropractic visit.[4] Other plans, like Plan K and Plan L, cover a percentage of the Part B deductible, reducing costs.
You can also opt for a Medicare Advantage plan through a private insurer. Some plans include additional coverage for chiropractic visits, but it varies.
Medicare and chiropractic visits FAQs
It can be challenging to determine if Medicare covers visits to the chiropractor. Here’s some additional information that may help.
How many chiropractic visits does Medicare Part B cover annually?
Medicare doesn’t limit the number of chiropractic visits. But coverage only extends to one type of treatment: manual manipulation of the spine. You also need documentation, either through an X-ray or in-person exam, showing that treatment is necessary.
Are there any specific conditions that you must meet for Medicare to cover chiropractic visits?
You must have documentation that you need treatment, either from an X-ray or in-person exam. You also need to require active or corrective treatment. Medicare doesn’t cover maintenance or preventative chiropractic care.
Does Medicare require a doctor’s referral for chiropractic care?
No. You don’t need a referral from your doctor to access chiropractic care through Medicare. But you need documentation from an X-ray or in-person exam showing you need active or corrective treatment due to subluxation.
What types of chiropractic treatments does Medicare cover?
Medicare only covers one type of chiropractic treatment: manual manipulation of the spine. The treatment is hands-on, and the provider uses movement pressure to increase functionality.
Are there any out-of-pocket costs associated with chiropractic visits under Medicare?
Medicare Part B covers chiropractic visits that are medically necessary. After you meet the annual deductible of $240, you’re responsible for a 20% copayment. Some Medigap plans cover the copayment, but you’ll still have to pay the deductible.
Sources
- Centers for Medicare and Medicaid Services. "Chiropractic Services."
- Medicare.gov. "What Part B covers."
- Centers for Medicare and Medicaid Services. "2024 Medicare Parts A & B Premiums and Deductibles."
- Medicare.gov. "Compare Medigap Plan Benefits."
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Taylor Milam-Samuel
Taylor Milam-Samuel is a writer and credentialed educator who is fascinated by how people earn, save, and spend their money. When she's not researching financial terms and conditions, she can be found in the classroom teaching.
Taylor has been a contributor at Insurify since February 2023.
15+ years in content creation
7+ years in business and financial services content
Chris is a seasoned writer/editor with past experience across myriad industries, including insurance, SAS, finance, Medicare, logistics, marketing/advertising, and many more.
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