How is Chiropractic Covered by Medicare A & B?
Chiropractic coverage in Medicare
Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture. If you think your chiropractor is billing Medicare for chiropractic services that aren’t covered, you can report suspected Medicare fraud Medicare.gov *
Medical Necessity get’s quite complicated.
Here’s more detailed definitions:
Here’s a Medicare Fact Sheet, something a little easier to read for the lay person.
For chiropractic services, medically necessary means the patient must have “a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct, therapeutic relationship to the patient’s condition and provide a reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine, as demonstrated by x-ray or physical exam.”
Patient must require treatment by means of manual manipulation.
Manipulation services rendered must have direct therapeutic relationship to the patient’s condition.
There must be a reasonable expectation of recovery or improvement of function resulting from the planned treatment. CMS.gov *
Note that the specimen Medicare Advantage policy we used to analyze coverage has exclusions on page 115 for chiropractic, they only cover what Medicare covers, nothing extra!
For those of you who think that “Medicare for All” will be the solution to every health problem and that Medicare pays everything, take a look at this NINE page bulletin on the the Medicare records required from your chiropractor.
Excerpts of Sample Medicare Advantage Plan
See above for Medicare definitions & requirements
Here’s an example where a Medicare Advantage plan is covering more than required
Medi Gap will provide coverage for the coinsurance amount or, in the case of hospital outpatient Services, the copayment amount of Medicare Eligible Expenses under Part B …, subject to the Medicare Part B Deductible provided the Subscriber is receiving concurrent benefits from Medicare for the same Services. Blue Shield EOC *
Other States may cover chiropractic, but CA doesn’t. Here’s a report from dynamic chiropractic.com
Chiropractor benefits available for Silver 1950 PPO and Silver 2600 HDHP PPO plans as of Jan 1, 2021
We are the first off-exchange health plan to offer embedded chiropractic services to members through the American Specialty Health (ASH) network with Silver 1950 PPO and Silver 2600 HDHP PPO plans.
$15 copayments for Silver 1950 PPO
35% coinsurance for Silver 2600 HDHP PPO
Both plans have an annual limit of 15 visits
There is coverage under Medicare A & B, Medi Gap and Medicare Advantage!
At one time you could Buy your OWN Chiropractic Plan!
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.
That's why the premium is very low or ZERO!