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I have been going to a chiropractor on a regular basis for the past five years. I recently enrolled in Medicare, and I’m confused and worried that I won’t be able to go to my standard chiropractic visits. They have given me so much pain relief. I’m wondering, does Medicare cover chiropractic in Florida?
Needing an adjustment,
Thomas from Broward, Florida
When you first enroll in Original Medicare Part A and B, it’s understandable that you’d be concerned about continuing your normal care. Plus, the parts of Medicare can be confusing. We’re happy that you reached out with your question.
The answer is – it depends.
Original Medicare Part B will cover medically-necessary chiropractic services for manual manipulation of the spine to correct a subluxation. A subluxation is when the bones in the spine are separated or out of alignment. An incomplete or partial dislocation is nearly always visible in X-rays.
Subluxation symptoms could include:
To remedy a subluxation of the spine, a chiropractor will adjust your spine with their hands (manually) to help realign the vertebra and relieve your symptoms.
“Original Medicare Part B does not cover chiropractic maintenance, but some Medicare Advantage plans provide this coverage.“
Chiropractic treatment is only covered by Medicare Part B when it is deemed medically necessary. And your primary care physician will determine this.
“Medically necessary” means the care needed to treat an illness, injury, condition, or disease. As long as the chiropractic visits are deemed medically necessary, Medicare may cover your visits. And your physician will provide the chiropractor orders once it’s determined that you have a spinal subluxation that requires chiropractic treatment.
Medicare Part B will only cover chiropractic services for a subluxation, either acute or chronic. Acute conditions usually occur suddenly and briefly, while chronic conditions develop slowly and worsen over time.
With Original Medicare, this treatment will still cost you. You first need to pay the Medicare Part B annual deductible, then 20% of Medicare-approved services once the Part B deductible is met. Medicare will pay the other 80% of the Medicare-approved cost.
If you have a Medigap plan, also known as a Medicare Supplement plan, that plan will cover all or part of the 20% Medicare Part B coinsurance cost.
Original Medicare will not cover other services or tests that a chiropractor or other qualified provider might order. These services include X-rays, ultrasound treatments, traction therapy, and massage therapy.
If the care you’ve been receiving from a chiropractor is for maintenance after your spine has been realigned, that would not be covered by Original Medicare.
If your chiropractic care is for maintenance, you should look into coverage under a Medicare Advantage plan. Medicare Advantage plans may provide additional chiropractic coverage – routine and maintenance chiropractic care – not covered by Original Medicare.
Medicare Advantage plans in Florida start at a $0 monthly premium and often include dental, vision, hearing, and other benefits – like chiropractic.
Depending on your Medicare plan, you may need prior authorization and a referral to an in-network chiropractor before your plan will pay. An agent can help you find a plan that includes the chiropractor you currently see.
I hope that this information was helpful and clarified your question on whether Medicare covers chiropractic in Florida. Being new to Medicare can be confusing, and you do not have to handle it alone.
At Connie Health, we help you throughout your Medicare journey. If you have additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711) for help.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.