Does Medicaid Cover Chiropractic Services? A Complete Guide

If you're considering chiropractic care but have limited financial resources, you may be wondering "Does Medicaid cover chiropractic services?"

Yes, it does cover some services.

Medicaid is a joint Federal and state program that provides healthcare coverage to eligible individuals with low incomes and limited resources. However, whether or not Medicaid covers chiropractic services depends on several factors, including the state in which you live and the specific Medicaid program you're enrolled in.

While some states do cover chiropractic services under their Medicaid programs, others do not. In some cases, chiropractic services may be covered only for certain conditions or providers may have limitations on the number of visits allowed. It's important to understand the benefits and limitations of Medicaid coverage for chiropractic care before making a decision about your healthcare options.

Benefits of Chiropractic Care

Chiropractic care is a type of complementary and alternative medicine that focuses on the musculoskeletal system and the nervous system. Chiropractors use manual techniques, such as spinal manipulation, to help alleviate pain and improve overall health and wellness.

Chiropractic care is generally safe and non-invasive, which makes it an attractive treatment option for many patients. It can also be less expensive than other types of healthcare services, such as surgery or prescription medications. For patients who are looking for a natural approach to healthcare, chiropractic care can be an excellent option.

Limitations of Medicaid Coverage for Chiropractic Treatments

As mentioned earlier, whether or not Medicaid covers chiropractic care depends on the state in which you live and the specific Medicaid program you're enrolled in. In some states, chiropractic care is not covered under Medicaid at all. In others, coverage is limited to certain conditions or has a cap on the number of visits allowed (for state-by-state information visit the Medicaid.gov site).

Even in states where chiropractic care is covered under Medicaid, there may be other limitations to consider. For example, some Medicaid programs require prior authorization before chiropractic services can be provided. Others may limit the types of services that are covered or the Medicaid fee that the chiropractor can charge for their services.

It's also important to note that not all chiropractors accept or pay by Medicaid. Before seeking chiropractic care under Medicaid, it's important to verify that the chiropractor you're considering accepts Medicaid and is enrolled as a Medicaid provider.

Chiropractic Services - What if You Have Medicare?

Medicare Part B is a component of the federal health insurance program for individuals who are 65 or older, disabled, or have certain chronic conditions. Medicare Part B does cover some chiropractic services, but the reimbursement is with limitations.

Medicare Part B covers manual manipulation of the spine to correct spinal subluxation (a misalignment of the vertebrae), but only when performed by a chiropractor or other qualified healthcare professional who is legally authorized to perform the service under state law. The service must also be deemed a medical necessity and must be provided in an office setting by a Medicare-approved chiropractor.

Under Medicare Part B, there is a limit on the number of chiropractic treatments that are covered in a calendar year. In 2023, Medicare covers up to 20 chiropractic visits per year. The beneficiary is responsible for paying the Part B deductible and 20% of the Medicare-approved amount for each service.

It is important to note that Medicare does not cover other services provided by chiropractors, such as an X-ray, massage therapy, or acupuncture. These services may be covered under Medicare Part B if they are deemed medically necessary and are provided by a healthcare professional who is authorized to provide them under state law.

Can You Combine Medicaid and Medicare?

Yes, it is possible for beneficiaries to combine Medicaid and Medicare to obtain additional healthcare coverage. This is known as "dual eligibility" and occurs when an individual qualifies for both Medicaid, a state-run program for low-income individuals, and Medicare, a federal program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease (ESRD).

It's important to note that the specific benefits and eligibility requirements of dual-eligible individuals vary by state and may change from year to year, so it's important to stay informed about your options and coverage.

Have You Considered a Medicare Advantage D-SNP Plan?

If you are on Medicaid, you may be eligible for a Dual Special Needs Plan (DSNP) – a type of Medicare Advantage plan designed for individuals who have both Medicare and Medicaid coverage. DSNP plans can provide you with many additional benefits beyond what Original Medicare and Medicaid provide, these may include routine chiropractic care, dental, vision, and hearing coverage, prescription drug coverage, and transportation services to medical appointments.

Some DSNP plans may also offer gym memberships, wellness programs, and over-the-counter allowances. If you're on Medicaid, it's definitely worth checking if you're eligible for a DSNP plan to see if you can get additional benefits and support to help you stay healthy.

Final Thoughts on Chiropractic Services Coverage with Medicaid and Medicare

Chiropractic care can be an effective and affordable option for many patients, but whether or not it's covered by Medicaid depends on several factors. If you're considering chiropractic care under Medicaid, it's important to understand the benefits and limitations of coverage before making a decision. To learn more about Medicaid coverage for chiropractic care in your state, contact your state's Medicaid agency or speak with a healthcare professional who is familiar with your Medicaid program work.