Understanding Medicare Coverage for Chiropractors

We understand how confusing insurance can be, so here’s a clear guide to how Medicare works for chiropractors, even if they provide physical therapy, and what it covers at our clinic.

What Medicare Does Cover

Medicare Part B covers spinal adjustments when:

  • They are medically necessary to treat subluxation (spinal misalignment).
  • Performed by a licensed chiropractor.

What Medicare Does Not Cover

Medicare does not cover:

  • Initial or follow-up exams.
  • Physical therapy exercises or stretches.
  • Manual therapy (e.g., soft tissue work).
  • Advanced therapies, such as:
    • Mechanical traction
    • Electrical stimulation
    • Class 4 laser therapy
    • Shockwave therapy
    • Dry needling
    • Pneumatic compression boots

What Are My Costs?

1. If You Only Have Medicare:

  • Medicare covers 80% of the cost of spinal adjustments after you meet your deductible.
  • You are responsible for:
    • 20% coinsurance for adjustments.
    • 100% of non-covered services.

2. If You Have Medigap (Supplemental Insurance):

  • Covers:
    • The 20% coinsurance for adjustments.
    • Possibly your deductible.
  • Does not cover non-Medicare services like exams or therapies.

3. If You Have Secondary Insurance:

  • May cover coinsurance, deductibles, or some non-Medicare services. Coverage depends on your plan.

How We Simplify the Process

  •  Insurance Verification: We’ll check your Medicare and supplemental coverage before your first visit.
  • Clear Pricing: You’ll always know the cost of non-covered services upfront.
  • Affordable Options: Our packages and memberships make advanced therapies more accessible.

Frequently Asked Questions

  • Frequently Asked Questions

    Q: Why doesn’t Medicare cover exams or therapies?

    Medicare’s chiropractic coverage is limited to spinal manipulation, and understanding why requires looking at its origins. This limitation reflects how chiropractic care was initially integrated into Medicare and the challenges of updating these policies to match modern care practices.

    Medicare’s chiropractic coverage is limited to spinal manipulation for a specific reason: the original Medicare guidelines were established to define chiropractic care narrowly. This approach reflects Medicare’s focus on medically necessary treatments for specific conditions, such as subluxation (spinal misalignment).

    1. Legislative Restrictions:

      Medicare laws specifically define chiropractic benefits narrowly, focusing only on spinal manipulation. This means services such as exams, physical therapy, and advanced treatments are excluded from coverage. These restrictions have been in place since Medicare's inception and have seen little change despite advancements in chiropractic care.

    2. Service Categorization: Physical therapy, manual therapy, and advanced treatments like laser or shockwave are categorized under separate healthcare providers, such as physical therapists or specialists. This creates a gap in coverage for chiropractors who incorporate these services into comprehensive care plans.

    3. Historical Precedent: When Medicare was created in 1965, chiropractic care was not as widely recognized for its broader rehabilitative capabilities. At that time, spinal adjustments were considered the primary and most evidence-backed contribution of chiropractors, leaving other services excluded from the policy framework.

    Q: How can I reduce my out-of-pocket costs for non-covered services?

    We offer packages and memberships to make advanced therapies more accessible and affordable.

    Q: How do I know what’s covered under my plan?

    We’ll verify your insurance benefits before your visit and explain what’s covered.

    Q: Can I still receive advanced therapies if Medicare doesn’t cover them?

    Yes! You can add advanced therapies like Class 4 laser, shockwave, or dry needling to enhance your recovery.