How many chiropractic visits does Medicare cover in a year? Learn the limits to Medicare chiropractic visits for spinal manipulation and the different plans available.
Chiropractic care can be an important part of managing pain, especially when it comes to back problems.
But if you’re on Medicare, it’s essential to understand what kind of coverage you have for these services.
How many chiropractic visits does Medicare cover in a year?
The answer isn’t always clear, and it depends on several factors, like medical necessity, your exact Medicare plan, and whether you have extra coverage.
In this article, we’ll break it down so you can clearly know what’s covered, how many times you can go for visits, and the amount you might spend.
What Chiropractic Care Does Medicare Cover?
Medicare covers some chiropractic care, but you need to know what services are covered.
Medicare Part B will only cover chiropractic services if they are medically necessary for spinal manipulation.
That means routine care like general chiropractic adjustments, wellness treatments, or massages are not covered by Medicare.
So what’s covered?
Medicare will cover chiropractic services if they involve spinal manipulation to correct a subluxation.
A subluxation is when the bones in your spine are out of alignment and causing pain or functional problems.
Medicare recognizes that spinal manipulation can help with these issues and therefore covers them.
However, other services like X-rays, acupuncture, or massage therapy that your chiropractor may recommend are not included in Medicare Part B.
Also, chiropractic adjustments not related to spinal manipulation for subluxation are excluded. So, while Medicare is a great resource for spinal issues, it has limits on what it will cover.
How Many Chiropractic Visits Does Medicare Cover in a Year?
One of the most common questions is, “How many chiropractic visits does Medicare cover in a year?”
The good news is Medicare doesn’t limit the number of chiropractic visits you can have.
However, each visit must be medically necessary to treat a specific spinal subluxation. There is no limit on the number of visits, but you’ll need to justify the need for ongoing treatment.
Each chiropractic visit is reviewed individually, so Medicare determines if the service is medically necessary for each visit.
As long as your chiropractor can show that the treatment is necessary, Medicare will cover each visit.
Keep in mind, though, that while there is no cap, Medicare won’t pay for services they deem excessive or unnecessary.
So, if your condition improves and chiropractic care is no longer needed, Medicare may stop covering the visits.
Also, after your deductible is met, Medicare Part B covers 80% of the services. You’ll be responsible for the remaining 20% unless you have supplemental insurance to cover that.
Some chiropractors may recommend services that Medicare won’t cover, so it’s important to know your full financial responsibility.
How Does Medicare Cover Chiropractic Care?
Medicare Part B is a part of Original Medicare that covers chiropractic care for spinal subluxation.
Under this plan, Medicare Part B will only cover the cost of spinal manipulation by a chiropractor for a specific medical condition.
This does not include diagnostic tests or other related services unless they are part of a medically necessary treatment plan.
Once you’ve met your deductible, Medicare will cover about 80% of the agreed cost for each chiropractic visit.
However, you’ll still be responsible for the remaining 20%, except if you have a Medicare Supplement Insurance Plan (Medigap), which helps cover those out-of-pocket costs.
Medigap plans are created to cover the gaps of Original Medicare and help you pay copays, coinsurance, and deductibles.
These plans are especially helpful if you’ll be needing ongoing chiropractic care.
For people registered in Medicare Advantage Plans (also known as Medicare Part C), the coverage is different.
These plans are offered through private insurers and usually provide extra benefits beyond what Original Medicare covers.
Your Medicare Advantage plan may cover more chiropractic adjustments or related services.
Check your plan’s details to see if it includes benefits like exercise equipment for rehabilitation or wellness programs.
Medicare Part B and Chiropractic Care
As mentioned earlier, Medicare Part B is the part of Original Medicare that covers chiropractic care for spinal subluxation.
Under this plan, chiropractic visits are only covered if medically necessary and involve spinal manipulation to correct a subluxation.
Diagnostic tests and other services like massage or physical therapy are not covered even if your chiropractor recommends them.
However, you should know that Medicare Part B doesn’t cover routine adjustments or other chiropractic care that doesn’t involve spinal subluxation.
If your chiropractor offers other services like nutritional counseling or physical therapy, you’ll need to pay out of pocket or pay through a different insurance plan.
Original Medicare does cover medically necessary spinal manipulation, but make sure you know what your plan covers and what it doesn’t.
Your chiropractor may recommend a service, but Medicare won’t cover it, so be sure to check before you agree to treatment.
Medicare Advantage and Chiropractic Coverage
For those with a Medicare Advantage Plan, the coverage for chiropractic care has a significant difference.
Medicare Advantage plans are expected to cover at least the same services as Original Medicare.
Yet, many of these plans provide extra benefits, like wellness programs or coverage for regular chiropractic services that are more than spinal manipulation.
If you have a Medicare Advantage HMO or Medicare Part C plan, it’s even possible that your plan will also cover extra chiropractic visits, wellness services, or other types of physical therapy.
Each plan is different, so it’s important to check your specific policy to see what kind of chiropractic coverage is included.
Most of the time, Medicare may cover chiropractic visits beyond what Original Medicare offers, especially if they are part of a larger wellness program.
This can be especially useful if you need regular chiropractic treatment or have chronic back pain that requires continuous care.
Costs and Out-of-Pocket Expenses for Chiropractic Care
When it comes to paying for chiropractic visits, the costs depend on your coverage.
As mentioned in previous sections, Medicare Part B will cover 80% of the accepted cost after you meet your deductible. This means you’ll be responsible for the other 20%.
This adds up as time goes on if you need frequent visits, which is why many people opt for a Medicare Supplement Insurance Plan to help with these costs.
Medigap plans aim to cover what Original Medicare does not. This helps to reduce your out-of-pocket expenses.
If you don’t have a Medicare supplement plan, you will likely need to pay the remaining 20% from your pocket.
For people with a Medicare Advantage plan, your costs may be lower. But ensure to always check with your insurer to know what’s included.
In addition, some chiropractors offer payment plans or discounts for services not covered by Medicare, so it’s worth asking about these options.
Always be clear about what it will cost to have chiropractic services before agreeing to treatments to avoid unexpected expenses.
Other Chiropractic Services Not Covered by Medicare
Medicare covers chiropractic services for spinal manipulation, but there are several other services that it doesn’t cover.
These include diagnostic tests like X-rays or MRIs and services like acupuncture or massage therapy.
Even though your chiropractor may recommend these services, Medicare won’t cover them unless they are part of your medically necessary treatment plan for subluxation.
If you have chronic back pain and your chiropractor recommends additional therapies, be sure to check if those services are covered by Medicare. If not, you’ll be surprised at the bill you’ll get.
Always ask your chiropractor in advance what’s covered and what’s not so you don’t get surprised later.
Conclusion
To end this, Medicare will basically cover chiropractic visits for spinal manipulation when they are medically necessary.
So, to answer the question of how many chiropractic visits does medicare cover in a year?
There’s particularly no exact limit on how many chiropractic visits Medicare covers in a year, but each visit must be medically justified.
If you’re on Medicare Advantage, your plan might provide extra benefits like routine adjustments or wellness services, which can lower your out-of-pocket costs.
To make sure you’re covered completely, always confirm with your chiropractor and Medicare provider about what services will be paid for.
Once you know your Medicare coverage for chiropractic care, it can save you from unexpected costs and help you get the treatment you need without stress.
