The answer will depend on the type of Medicare part you have. There are some similarities but differences in the coverages offered by Medicare Part B and Medicare Part C (aka Medicare Advantage Plans). As a note: Medicare Part A is for hospital care and emergency procedures only, so Part A coverage does not apply here. Traditional Medicare Open Enrollment runs from October 15th to December 6th each year. Medicare Advantage plans run from January 1st to March 31st each year.
Medicare Part B
The quick answer is yes, but coverage is limited and subject to medical necessity.
Medical necessity is defined as - “Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” This means that if an acute injury is sustained that can be treated by a chiropractic adjustment to assist in correction/rehabilitation of the issue or injury, it will be covered under medical necessity by Medicare Part B. Medicare Part B will not cover these services if treatment is sought as preventative or maintenance care.
It is essential to understand that the only covered chiropractic service by Medicare Part B is manual manipulations of the spine to correct a subluxation (a condition when the vertebrae are misaligned). For medically necessary chiropractic treatments, there is no visit limit set by Medicare Part B, but it is based on how your body responds and progresses to reach maximum improvement. Once you reach this point, Medicare Part B will no longer cover chiropractic adjustments, known as entering maintenance treatments. Medicare Part B is subject to an annual deductible that must first be met before they begin to pay for treatments received. After the deductible is met, Medicare will pay 80% of the contracted rate, and the patient is responsible for the remaining 20%.
If you have additional medical coverage, such as a Medicare Supplemental policy or true secondary policy, that policy might pick up some of the cost, depending on your plan and the coverages outlined in your policy. Please be aware that Medicare Part B NEVER covers exams or other services provided by a Chiropractor, such as X-rays, cold laser therapy, massage, or acupuncture.
Medicare Part C - Medicare Advantage Plans
If you have a Medicare Advantage plan through a health insurance company (such as Regence, Premera, Aetna, Humana, United Health Care, etc.), there may be additional coverage under the policy’s chiropractic benefits. Medicare Advantage plans must cover at least the same chiropractic services as outlined above for Medicare Part B. Still, deductibles, coinsurances, and copays will vary based on the plan/policy that was selected during open enrollment.
It has been our experience that many Medicare Advantage plans offer coverage for routine/maintenance services (to a visit limit), but this is dependent on your plan's policies and benefits. Exams are often not a covered service. We bill the insurance for the exam as a courtesy and precaution to have the ‘home group’ review and process the claim to give a definitive answer as to whether the exam is covered or not by the policy.
In Conclusion
Medicare does cover manual spinal manipulations (adjustments) when medically necessary, but typically, there is no coverage outside of an acute injury. No matter what type of Medicare plan you have, we are here to help you understand your benefits and to get you feeling better.
Open enrollment starts in October, allowing you to change insurance for the following year. This is the best time to review your policies and make any changes to your insurance carriers and/or plan levels/coverages.
Please contact your insurance carrier or insurance broker to discuss your coverages and any changes that can be made to make sure your coverages are what you are looking for. If you have any questions, we are always happy to answer them, or you can email Cami for clarification at cami@vitalitychiropractic.com.
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