The answer is yes and no.
Yes, a series of chiropractic treatments will be mostly, if not fully, covered by Medicare treatment that is deemed "medically necessary". Treatment is usually covered for 6-10 weeks of consistent treatment depending on the diagnosis and progress. If there is an an active complaint or injury along with a clinical treatment plan including a start and end date of care, Medicare will cover spinal adjustments at 80%. Most secondary insurance plans will cover the left over 20% that Medicare does not cover. This makes the spinal adjustment fully covered by insurance during the active treatment and "medically necessary" phase of care.
But, there are some limitations.
1. Medicare does have a deductible that restarts every year. In 2023 the Medicare deductible is 226.00. Some Medicare plans waive the deductible and some secondary insurance plans pick up Medicare deductible so you might not even notice there is one.
2. Medicare does not currently cover initial examinations even though they are required to receive treatment. Initial examinations are paid out of pocket.
3. Medicare does not currently cover any additional therapies or treatments besides a spinal adjustments. This means that any extremity work, myofascial work, muscle stimulation, or massage will be out of pocket.
4. Medicare does not currently cover visits that are for wellness or preventative purposes. Without a specific injury and specific treatment plan, Medicare does not consider treatment "medically necessary." Despite this, we educate all of our patients that wellness and preventative care is often worth the out of pocket costs to reduce your flare ups and maintain your progress. Your health is your choice! Don't let an insurance company dictate what is best for your wellness.
Luckily, there is a bill that chiropractic lobbyists are working hard at passing which expands the Medicare coverage for chiropractic. Since 1972 Medicare only covers one of the many different services that chiropractors are licensed to provide. This drastically limits Medicare beneficiaries treatment options provided by a chiropractor and often prevents them going in the first place.
"The Chiropractic Medicare Coverage Modernization Act (H.R. 1610 / S. 799) would bring Medicare’s coverage of chiropractic into alignment with most other federal programs and private health plans, giving seniors improved coverage of non-drug treatments to alleviate pain and improve function." -ACA Today
If you have questions about your Medicare insurance please reach out to us and we can check your specific plan. There are a variety of Medicare based plans such as Medicare advantage and Medicare replacement plans which often include a flat co-pay amount.
From the desk of Dr. Lisette Miller Kondrad. Dr. Miller is a licensed Chiropractic Physician and Board Certified Acupuncture Provider. She has helped hundreds of patients through chiropractic care and acupuncture. Click here to contact Clark Road Chiropractic Center with any questions or to schedule your appointment!