by Russell Noga | Updated November 26th, 2023
Does Medicare Plan N Cover Chiropractic Services?
Are you wondering, “does Medicare Plan N cover chiropractic services?” You’re not alone. Many people rely on chiropractic care for relief from spinal issues and overall health, so it’s essential to know the extent of your coverage.
In this blog post, we’ll provide a comprehensive answer to this question, exploring the different aspects of Medicare and how each part affects your chiropractic coverage. Let’s dive in!
- Medicare Plan N is a supplemental insurance policy that covers some out-of-pocket expenses for Part B services, including manual manipulation of the spine to correct a subluxation.
- Medicare coverage for chiropractic services varies between Parts A, B and C with Part B offering 80% coverage of the cost of medically necessary spinal manipulation and some Medicare Advantage plans offering additional coverage.
- Choosing a Medicare approved chiropractor and staying within medically necessary treatment limits can help individuals maximize their chiropractic care under Plan N while receiving needed care without incurring additional costs.
Understanding Medicare Plan N
Navigating the world of healthcare coverage can be confusing, especially when it comes to chiropractic services.
Medicare Plan N is a Medigap policy designed to help cover out-of-pocket costs for these services, including coinsurance and copayments.
But what exactly is Medicare Plan N, and how does it interact with chiropractic care? Let’s break it down.
What is Medicare Plan N?
Medicare Plan N is a supplemental insurance policy meant to fill the gaps left by Original Medicare (Parts A and B).
It provides coverage for 100% of Part B services, except for copayments for certain office visits and some emergency room visits. This means that when it comes to chiropractic services, Medicare Plan N can help you avoid or minimize out-of-pocket expenses.
However, it’s important to note that Medicare Plan N does not cover every service. Services not covered by Original Medicare, such as long-term care, vision, and dental services, are also not covered by Medicare Plan N.
Thus, Medicare Plan N is best thought of as one of the medicare supplement plans that helps with out-of-pocket expenses for covered services.
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Chiropractic services under Medicare Plan N
When it comes to chiropractic services, Medicare Plan N specifically covers manual manipulation of the spine to correct a subluxation, as long as it is deemed medically necessary.
This means that if you require spinal adjustments to alleviate pain or discomfort caused by a misaligned or displaced vertebra, Medicare Plan N can help cover the costs of these treatments.
Keep in mind that out-of-pocket expenses for chiropractic services under Medicare Plan N include coinsurance, deductibles, and copayments. As long as you stay within the guidelines for medically necessary treatments, you can expect Medicare Plan N to provide coverage for these chiropractic services.
Coverage of Chiropractic Services by Medicare Parts A, B, and C
Understanding how Medicare covers chiropractic services is crucial for making informed decisions about your healthcare.
Here is a breakdown of how each part covers chiropractic services.
- Medicare Part A: Does not cover chiropractic services. This part focuses on hospital and emergency care.
- Medicare Part B: Covers 80% of the cost for medically necessary spinal manipulation. This includes adjustments to correct subluxation of the spine.
- Medicare Part C (Medicare Advantage): Coverage for chiropractic services may vary depending on the specific plan. Some Medicare Advantage plans may offer additional coverage for chiropractic services beyond what is covered by Part B.
It is important to review your specific Medicare plan to understand the coverage and any limitations or requirements for chiropractic services.
Let’s delve deeper into the coverage provided by Medicare Parts A, B, and C to better understand how each part affects your chiropractic care.
Medicare Part A
Medicare Part A primarily provides medicare coverage for:
- Inpatient hospital care
- Skilled nursing facility care
- Hospice care
- Laboratory tests
- Home health care
Chiropractic care, however, is not included in the services covered by Medicare Part A.
Medicare Part B
Medicare Part B is more relevant to chiropractic care than Part A. Under Part B, medically necessary spinal manipulation is covered, with Medicare paying for 80% of the costs of these services.
This means that if you need chiropractic care to correct a spinal subluxation, you’ll only be responsible for 20% of the procedure cost, which typically falls between $6 and $10.
However, it’s important to note that if you visit a chiropractor who does not accept Medicare, you may be liable for the full cost of the service. Therefore, choosing a Medicare-approved chiropractor is crucial for maximizing your coverage under Part B.
Medicare Part C (Medicare Advantage)
Medicare Advantage plans, also known as Medicare Part C, are private health insurance plans approved by Medicare. They provide coverage for hospital, medical, and other healthcare services, sometimes including chiropractic care.
Some Medicare Advantage plans may offer additional chiropractic coverage beyond what is covered by Original Medicare. To find out what chiropractic services are covered by your Medicare Advantage plan, it’s best to contact your plan directly.
Expenses for chiropractic treatments under Medicare Advantage plans typically range from $5 to $20 per adjustment, depending on the plan and provider. Copayments for chiropractic visits under Medicare Advantage may also vary, so it’s essential to understand your plan’s specific coverage and costs.
Out-of-Pocket Costs for Chiropractic Services with Medicare Plan N
As mentioned earlier, out-of-pocket costs for chiropractic services under Medicare Plan N include coinsurance, deductibles, and copayments.
While Medicare Plan N covers the 20% coinsurance for chiropractic services, the annual Part B deductible still applies.
Let’s take a closer look at these costs and how they affect your chiropractic care.
Coinsurance and Deductibles
Medicare Plan. N covers the following for chiropractic services:
- 20% coinsurance for medically necessary spinal manipulation
- Once you’ve met your annual Part B deductible, you won’t have to pay any extra costs
- In 2022, the annual Part B deductible was $233, and in 2023, it is $226
- This deductible must be met before Medicare starts covering the costs of your chiropractic care.
It is important to note that Medicare Plan N does not cover any other chiropractic services.
Copayments for chiropractic services under Medicare Plan N may vary depending on the plan and provider.
In general, you may be liable for a copayment of either $20 or $30 for each chiropractic visit with Medicare Plan N, which is a part of the overall medicare pay structure.
Be sure to check with your specific plan to determine the exact copayment amount required for your chiropractic services.
Additional Chiropractic Services Not Covered by Medicare
It’s essential to be aware of additional chiropractic services not covered by Medicare. Medicare does not provide coverage for regular maintenance or preventive chiropractic visits, treatments to other parts of the body, or acupuncture (except for chronic low back pain).
Knowing what services are not covered can help you make informed decisions about your chiropractic care and seek alternative coverage if necessary.
Non-covered treatments include maintenance visits, non-spinal chiropractic treatments, and most acupuncture services.
Medicare only covers manual manipulation of the spine to correct a subluxation, so other services or tests ordered by a chiropractor, such as X-rays, massage therapy, or acupuncture, are not included in your chiropractic treatment coverage. However, it’s essential to know if Medicare covers chiropractic treatments in your specific case.
Being aware of these non-covered treatments can help you make informed decisions about your chiropractic care and avoid unexpected out-of-pocket expenses. If you require any of these services, you may need to seek alternative coverage or be prepared to pay for them out of pocket.
Finding Alternative Coverage
For non-covered chiropractic services, alternative coverage may be available through private insurance or employer-sponsored plans.
Some Medicare Advantage plans may also offer additional coverage for chiropractic care beyond what Original Medicare covers. To better understand if Medicare covers chiropractic services, it’s essential to explore the specific benefits of your Medicare Advantage plan.
To find alternative coverage for non-covered chiropractic services, it’s best to shop around and compare different plans offered by private insurance companies or inquire with your employer about any available chiropractic benefits. By exploring your options, you can ensure that you have the coverage you need for all aspects of your chiropractic care.
Maximizing Chiropractic Coverage with Medicare Plan N
To maximize chiropractic coverage with Medicare Plan N, it’s essential to choose a Medicare-approved chiropractor and stay within medically necessary treatment limits.
By doing so, you can ensure that you receive the care you need without incurring unnecessary out-of-pocket expenses.
Many people wonder how many chiropractic visits are covered by their insurance. Medicare Plan N covers up to 12 chiropractic visits per year, with a $2,000 premium.
Choosing a Medicare-approved Chiropractor
Selecting a Medicare-approved chiropractor ensures that Medicare will cover 80% of the cost for medically necessary spinal manipulation. You can find a list of Medicare-approved chiropractors on the Medicare website or by contacting your Medicare plan directly.
When choosing a Medicare-approved chiropractor, it’s crucial to ensure that the chiropractor is licensed and qualified to provide chiropractic services. Additionally, verify whether the chiropractor accepts Medicare assignment, which means they agree to accept the Medicare-approved amount as full payment for their services.
Staying Within Medically Necessary Limits
Staying within medically necessary limits means receiving chiropractic care only for spinal subluxation diagnosed by a physician, with no limit on adjustments as long as they are medically necessary.
In other words, if your doctor determines that chiropractic care is necessary to treat your spinal subluxation, Medicare Plan N will continue to cover the costs of your adjustments.
By adhering to these medically necessary limits and choosing a Medicare-approved chiropractor, you can maximize your chiropractic coverage with Medicare Plan N. This ensures that you receive the care you need without incurring unnecessary out-of-pocket expenses.
In conclusion, understanding your chiropractic coverage under Medicare Plan N is crucial for making informed decisions about your healthcare. While Medicare Plan N covers medically necessary spinal manipulation, additional treatments like maintenance visits and acupuncture are not covered.
By choosing a Medicare-approved chiropractor and staying within medically necessary limits, you can maximize your coverage and ensure that you receive the chiropractic care you need without incurring unexpected out-of-pocket expenses. Stay informed and take control of your healthcare, so you can focus on what truly matters – your health and well-being.
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Frequently Asked Questions
Does Medicare pay for xrays at a chiropractor?
Medicare does not cover X-rays ordered by a chiropractor.
However, it may cover an X-ray ordered by a physician to diagnose a medical condition if it is related to a spinal subluxation.
What diagnosis codes does Medicare cover for chiropractic?
Medicare covers CPT codes 98940, 98941, and 98942 for chiropractic services when billed with appropriate primary diagnosis codes without modifier AT.
Working with a chiropractic coding expert makes submitting claims easier.
Does Medicare cover physical therapy for back pain?
Yes, Medicare generally covers physical therapy for back pain. Part B covers 80% of allowable charges after you meet your Part B deductible for treatments from a doctor’s office, hospital, or outpatient center.
Part A also provides coverage for inpatient treatments for back pain.
Does Medicare require modifier at for chiropractic?
For chiropractic services, Medicare requires the use of an AT modifier on CPT codes 98940–98942 when active treatment is being provided to treat acute or chronic subluxation. The presence of the AT modifier does not automatically indicate that the service is medically necessary.
Does Medicare Plan N cover all chiropractic services?
Unfortunately, Medicare Plan N does not cover all chiropractic services, such as maintenance visits, non-spinal treatments, and most acupuncture services. It only covers medically necessary spinal manipulation to correct a subluxation.
Find the Right Medicare Plan for You
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Call us today at 1-888-891-0229 and one of our knowledgeable, licensed insurance agents will be happy to assist you!
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.