DOES MEDICARE COVER CHIROPRACTIC CARE?
First of all, the quick answer is that Original Medicare does not usually cover non-traditional medical care, such as chiropractic care or acupuncture.
However, this is not the whole story and there are some exceptions to this rule that we will explain.
In order to do this, it is important to understand the Medicare program and how coverage is provided.
THE MEDICARE PROGRAM
As you probably know, Medicare is organized into Parts, specifically Parts A, B, C, and D. When you enroll in the Medicare program, you have to choose which Parts you want to sign up for. Each Part covers very specific medical costs.
The parts then fall into different categories of Medicare coverage:
- Original Medicare which covers Parts A and B
- Medicare Advantage which covers Part C (and sometimes D)
- Prescription Drug Plan which covers Part D
Please see the chart below.
WHAT IS COVERED BY ORIGINAL MEDICARE?
Original Medicare is a traditional fee-for-service healthcare insurance program offered directly through the federal government. Original Medicare is made up of Medicare Part A and Medicare Part B. These Parts cover hospital care and outpatient care.
This means Original Medicare covers care that happens in a hospital or inpatient healthcare facility, like a skilled nursing facility or nursing home. It also covers the costs of hospice care and home health services.
Inpatient coverage includes medical supplies and prescription drugs you receive while you are in the facility. If you are homebound, Part A will cover your physical and occupational therapy. For terminally ill patients, Part A also covers expenses related to doctor visits, medication, and grief counseling.
In addition to hospital services, Original Medicare also covers outpatient services through Part B.
This means Original Medicare will cover preventive services and medically necessary outpatient services.
This includes the care required to diagnose and treat your medical illnesses or conditions, including doctor visits, lab work, medical tests, and medical equipment or devices.
Preventive services are those healthcare services that you receive in order to prevent illness, like a flu shot, early detection screenings and tests, and routine physicals.
Additionally, Part B also covers ambulance services, durable medical equipment (DME), outpatient mental health services, any second opinions required for medical advice, and even a very limited amount of prescription drug coverage.
CHIROPRACTIC CARE UNDER ORIGINAL MEDICARE
While Original Medicare usually doesn’t cover chiropractic care, there is one case in which it is covered under Medicare Part B.
This situation when chiropractic care is very rare and only occur when chiropractic care is deemed “medically necessary.”
The government defines “medically necessary” as: “health care services and supplies needed to diagnose to treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
The only kind of chiropractic care which Medicare medically necessary is subluxation, and only subluxation.
Subluxation is a diagnosed condition where one or more of the bones of your spine are out of position.
This misalignment is associated with pain in the back and neck, usually creeping up over time, as well as headaches.
The amount of discomfort and pain from spinal subluxation can vary. Some sufferers are unable to move without great pain, while others have stiffness and inflexibility.
Keep in mind that while subluxation is covered under Part B of Medicare, the diagnosis isn’t. Medicare will not cover x-rays, massage therapy, or acupuncture that might be recommended by your chiropractor. Only the actual chiropractic treatments for subluxation will be covered.
Be aware also that Medicare will only cover a limited number of treatments, which may be less than your doctor and/or chiropractor recommend. Any additional treatments you undergo above this limit will have to be covered out-of-pocket.
Always make sure that your chiropractor is Medicare-certified if you are being treated for subluxation and want to be covered under Medicare Part B. Not all of them are.
WHAT IS COVERED BY MEDICARE ADVANTAGE?
Medicare Advantage is an insurance policy provided by a private health insurance company that contracts with the federal government to provide healthcare coverage.
As we said, Medicare Advantage plans are made up of Medicare Part C, which by law, covers all the same things as Medicare Parts A and B.
This means that Medicare Advantage includes both hospital care and outpatient care.
Medicare Advantage plans generally differ from Original Medicare in that they are administered by private insurance companies, and they usually have limitations on where you can receive your care.
Limiting your medical care to a specific service area, allows the insurance company to provide the inpatient and outpatient coverage at a lower premium than Original Medicare.
Most Medicare Advantage plans will also include Part D, or prescription drug coverage, as part of their Medicare package. Some Part C plans even offer basic dental and vision coverage. You can shop around for a policy that has the benefits you want.
CHIROPRACTIC CARE UNDER MEDICARE ADVANTAGE
The good news is that because Medicare Advantage plans are offered by private insurance companies, many of them also offer chiropractic care as part of their plan.
This means that chiropractic care is covered by Medicare through many Medicare Advantage plans.
In addition to covering chiropractic care for subluxation, a Medicare Advantage plan will cover a much broader range of chiropractic services.
You’ll need to check your specific plan to see what its terms are regarding chiropractic care, and if you regularly use chiropractic services as part of your healthcare regimen, you should shop specifically for plans with this feature.
Chiropractic care—both the amount of visits and the kind of care you can receive—will obviously vary from plan to plan and from insurance carrier to carrier.
Since Medicare Advantage plans are not standardized, each plan can offer a wide variety of benefits under different premiums and copays.
Just so you know, in general Medicare Advantage plans that cover acupuncture is very rare but can be found if that is a high priority for you. Chiropractic care is much more widely available for patients.
WHAT OTHER OPTIONS
DO I HAVE TO RECEIVE CHIROPRACTIC
CARE UNDER MEDICARE?
Another way to get chiropractic care coverage under Medicare is to get a MediGap policy.
WHAT IS COVERED BY A MEDIGAP POLICY?
Because the out-of-pocket costs under Original Medicare can be high in some cases, the federal government authorized the creation of Medicare Supplement Insurance plans, also known as MediGap.
These are supplemental insurance policies offered by private insurance companies that can add to the coverage under Medicare Parts A and B and help pay for other out-of-pocket expenses, such as deductibles, coinsurance, and co payments.
In order to obtain a MediGap policy, you must be enrolled in Medicare Part A and Part B, also known as Original Medicare.Keep in mind that this monthly premium will be paid to a private insurance company in addition to the monthly Part B premium that you pay to the federal government.
Every MediGap policy has to be structured according to federal and state laws which are designed to protect you. All MediGap policies must be clearly labeled as “Medicare Supplement Insurance” by the private insurance company.
For your information, private insurance companies can only sell you “standardized” policies that identified in most states by letters: A, B, C, D, F, G, K, L, M or N
CHIROPRACTIC CARE UNDER MEDIGAP
In order to get chiropractic care under MediGap, you will need to select the right MediGap plan which covers this kind of care.
These plans are Medigap plan “C” and plan “F” which cover 100% of your Part B deductible and will also pay the 20% coinsurance.
If you combine Original Medicare with one of these plans, there would be no charge for any medically necessary chiropractic work, however, there may be limitations based on what is determined to be medically necessary.
Check with a Medicare insurance expert to know if these plans will meet your chiropractic needs before you purchase a policy.
Also, keep in mind that unfortunately MediGap policies only provide coverage for one person. If you and your spouse both want to have MediGap coverage in order to obtain chiropractic care, then you will each need to purchase a separate MediGap policy.
Please note that beginning January 1, 2020, all MediGap plans sold to new enrollees with Medicare will no longer be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available for people new to Medicare starting on January 1, 2020.
However, if you are already enrolled in either of these two plans or you obtain coverage under one of these plans before January 1, 2020, then you’ll still be able to keep your plan. (Also, if you became eligible for Medicare before January 1, 2020, but have not yet completed your enrollment, you may be able to get enrolled in one of these plans.)
Another option for those who want to purchase a MediGap policy to help cover chiropractic care after January 1, 2020 is to purchase Plan G, which would cover your coinsurance and copayments for medically necessary chiropractic care, but not your deductible.
HOW DO I FIGURE OUT WHICH MEDICARE
PLAN IS BEST FOR MY CHIROPRACTIC NEEDS?
Even with this thorough discussion of what kinds of chiropractic care is available to you through Original Medicare and Medicare Advantage plans, it can be confusing and overwhelming as you consider your choices.
How will you decide what is best?
How will you make sure you can get the chiropractic
care you need?
Luckily, you do not have to make these decisions alone. Many people are ready and able to help you navigate the Medicare options that are available for you, including for chiropractic care, and the best place to start is with licensed and experienced Medicare insurance agents.
At Insurance Professional of Arizona, we have a knowledgeable team of brokers that are long-time experts in Medicare insurance. As you sit down with them and discuss your particular healthcare needs and preferences, they can use their decades of expertise and understanding of the Medicare rules to help answer your questions and help you find the right plan for you.
Does it make more sense to choose Original Medicare? Or would you be better off with Part C and the extra coverages and broader chiropractic options that come with it?
If you decide to go with Original Medicare, does it make sense to add a MediGap policy to help defray the costs of out-of-pocket, medically necessary chiropractic care?
Are you more concerned about your premiums and costs, your particular service area, or more concerned about getting the kind of specialized care available through chiropractic services? Using these questions and many more, our brokers can help you find the Medicare policy that serves your needs and priorities.
Don’t make this decision without a thorough assessment of your needs. Our brokers are ready to listen to your questions, understand your priorities, and answer all your questions so that you end up with the right Medicare plan for you.
Please contact our office for help in setting up your Medicare plan.
We will walk you, step-by-step, through the enrollment process after thoroughly evaluating your personal needs, so that you have the benefits you need without ever paying any penalties or getting stuck without coverage.
Best of all, because we are independent insurance brokers, we can shop the policies and premiums of dozens of companies so that you can get exactly what you need out of your Medicare insurance at a price that fits your budget.
To get started today, just call us or fill out the contact form right here on our website.
At IPA, no matter what your heath care needs are, our experienced and professional Medicare agents are here to help you successfully navigate the Medicare enrollment process to be able to access the services and care that are right for you.
We’re here to help! Call us today.