Chiropractic care, a form of complementary care, involves manual manipulation and emphasis on the body’s ability to heal itself. Proponents point to successful results for many people suffering from back and neck pain, without use of potentially addictive narcotics or surgery.
Is chiropractic care covered by Medicare?
Medicare will only cover chiropractic care by a certified practitioner to correct a condition called vertebral subluxation—when the spinal joints fail to move properly. It will not pay for other services or tests ordered by a chiropractor, including x-rays, massage therapy or acupuncture. X-rays must be ordered by your primary care provider, if necessary to confirm that spinal subluxation is medically necessary. If a chiropractor orders X-rays or other diagnostic tests, you’re on the hook to pay for them, according to the American Chiropractic Association.
The limitations on services date back to 1972, when a statute was included in Medicare that said the only thing covered in chiropractic care is “manual manipulation of the spine to correct a subluxation,” says John Falardeau, senior vice president of public policy and advocacy at the American Chiropractic Association.
“While there are many more Medicare covered services that a chiropractor can provide, they are handcuffed by the statute, which limits patients to just that one service,” he says.
What is subluxation of the spine?
This condition happens when the vertebra is out of alignment. You may experience backaches, headaches, stiffness or pain due to compressed nerves. Subluxation can be caused by a chronic condition or from an acute event, like whiplash or a serious fall. A chiropractor will assess and manually adjust the spine to help realign the vertebra.
While there’s no limit on the number of visits for the initial medically necessary care, Medicare won’t pay for continuing, or maintenance, chiropractic care, once the spine is realigned. That can leave many patients with difficult choices, says Falardeau—pay for the services themselves, resort to narcotics for pain relief, undergo surgery, or live with pain.
These options lead to inequities and health disparities, wrote Robert Leach, a doctor of chiropractic medicine and adjunct instructor at Mississippi State University. “Use [of chiropractic care] is lower among vulnerable populations: seniors, lower income women, and Black and Hispanic beneficiaries who may be most affected by current inequities associated with the limited coverage.”
Falardeau has been lobbying Congress to change the current Medicare provision for two decades. “The only way to fix the statue is through legislation,” he explains.
Bills currently making their way through the House and the Senate would eliminate the existing statute and put chiropractors (who earn a doctor of chiropractic medicine degree, or DC) on par in Medicare with MDs (medical doctors) and DOs (doctors of osteopathic medicine), allowing them to practice to the full scope of state license, including ordering tests and screenings.
“We're really optimistic that we can get this across the finish line this year,” he says.
How much does chiropractic care cost with Medicare?
If you opt to see a chiropractor and have traditional Medicare, you will need to meet the Medicare Part B deductible ($226 in 2023), and then pay 20% of the Medicare-approved amount. If you have Medigap insurance, it will cover the remainder. Some Medicare Advantage plans provide chiropractic coverage beyond Medicare’s coverage scope, but each plan has its own criteria, so if you have a Medicare Advantage plan, check with them to make sure you understand the guidelines.
Older adults and back pain
A 2022 Harris Poll found nearly 3 in 10 adults (28%) experienced chronic low back pain. About half described their pain as moderate, but more than a third (36%) said their pain was severe. The likelihood of back pain increases with age, and is most common in adults 75 and older, followed closely by those 65 to 74, according to the Center for Advancing Health. Much of this is attributable to age-related loss of physical function and deterioration of the musculoskeletal system. Lack of exercise, excess weight, genetics, stress, anxiety and poor sleep can all affect your back.
While most patients visit one of the 70,000 licensed chiropractors in the U.S. for back pain, these professionals can also care for other conditions, says Falardeau. They’re skilled in soft-tissue therapy and joint manipulation to address problems with bones, nerves, muscles, tendons, and ligaments.
The profession has been around for about 100 years, yet only about 10% of U.S. adults received chiropractic care in 2017 (latest data available), according to the National Center for Complementary and Integrative Health, part of the National Institutes of Health. Misconceptions about the field, pushback from some medical doctors, and until recently, lack of insurance coverage, led may people to hesitate seeking care. Yet evidence continues to grow about the effectiveness of chiropractic care, especially as an alternative to opioids.
