Back pain affects millions of adults, and according to the American Chiropractic Association, an estimated 31 million Americans experience the condition at any given moment. It is a leading cause of disability worldwide, keeping millions of people from working or participating in everyday activities. Many turn to chiropractic care for relief, and research shows that about 14% of chiropractic patients are those age 65 and older.
“Chiropractic care is sought by a growing population of seniors who want effective and affordable alternatives to more invasive, expensive and higher-risk treatments,” says Dr. Steven Saro, a chiropractor and the legislative chairman of the Massachusetts Chiropractic Society in Braintree, Massachusetts. “Studies have shown that seniors who utilize chiropractic services require less pain medication, less anti-inflammatory medication and less invasive medical care.”
For seniors managing the everyday aches and pains that can come with aging, this raises an important question: What does Medicare cover?
[READ Pain and the Mind-Body Connection]
What Is a Chiropractor?
Chiropractors are health care professionals who focus on diagnosing and treating conditions related to the musculoskeletal system. They use hands-on techniques, such as spinal adjustments and manipulations, to improve alignment, mobility and function. In addition to adjustments, chiropractic care often includes treatments such as heat or cold therapy, exercises, stretches and other techniques to support overall health. The primary goals are to relieve pain, restore proper alignment and function and support the body’s natural ability to heal with minimal reliance on medications or surgery.
For seniors, chiropractic care can be especially valuable. As the body ages, musculoskeletal issues and reduced muscle flexibility become more common. One study showed that chiropractic care helps reduce functional decline in the activities of daily living, such as bathing, dressing and eating. Also, by addressing spinal alignment and joint health, chiropractic care may also support better balance and stability, which can lower the risk of falls, which is a major concern for older adults.
“Chiropractic care improves mobility and balance in the senior population by increasing range of motion, enhancing joint function, improving muscle tone and stimulating nerves to improve balance and coordination,” Saro says.
At your first visit, you will be asked for a detailed health history, including any medications, surgeries and details about your current condition and any prior diagnoses and treatments. Part of the visit includes a neurological and orthopedic exam, along with screening for common conditions people often face as they age.
“In seniors, spinal and pelvic X-rays are also often indicated to thoroughly assess structural integrity, degenerative changes, factors affecting mobility and other conditions,” Saro says.
[READ: Proven Ways to Relieve Muscle Soreness]
What Does Medicare Cover?
While chiropractors also treat neck, joint and other conditions, Medicare Part B, part of original Medicare, pays for only one service — manual manipulation of the spine to correct a chronic or acute vertebral subluxation. This is when one or more spinal bones are dislocated and fail to move properly, causing pain and reduced mobility.
These criteria must be met before Medicare covers chiropractic care:
— You must be diagnosed with a vertebral subluxation.
— In order to correct the misalignment, manual manipulation must be necessary.
— The chiropractor must be a Medicare provider.
There are no limits from Medicare on the amount of chiropractic adjustments you can have, but each visit must be considered medically necessary.
While Part C, also called Medicare Advantage, plans must cover everything original Medicare does, check with your plan to see if it offers any additional chiropractic benefits. You may need to budget for copays and coinsurance, need a referral from your primary care doctor or have in-network restrictions.
Physical therapy for back pain is covered, but massage therapy is not.
Medicare will also cover acupuncture for chronic lower back pain if the following criteria are met:
— Pain lasts 12 or more weeks.
— There is no known cause.
— It is not associated with surgery or pregnancy.
— Procedures are performed by a doctor or health care professional (such as a nurse practitioner) who is licensed to practice acupuncture in your state, who has advanced acupuncture training from an accredited school and who is a Medicare provider.
Up to 12 treatments within 90 days may be covered for lower back pain. Medicare may cover an additional eight sessions if you show documented improvement.
[READ Understanding Parts of Medicare: A Through N Explained]
What Does Medicare Not Cover?
Medicare restricts chiropractic coverage to only the correction of chronic or acute vertebral subluxation by manual manipulation.
— Initial exam
— Chiropractor-ordered X-rays or other diagnostic tests
— Ongoing maintenance care
— Treatment for other areas of the body, such as the neck, arms or legs
“Before beginning treatment, in order to determine medical necessity, Medicare requires additional services, such as an examination and, often, diagnostic imaging like X-rays to establish a diagnosis. These required services are not covered by Medicare when performed by the chiropractor, placing the costs on the patient,” says Albert Katler, the Medicare advising director.
It’s important to note that while Medicare will not cover X-rays or other diagnostic tests ordered by a chiropractor, it will cover them if ordered by your primary care doctor.
Other treatments that chiropractors use that Medicare does not cover include:
— Cold therapy
— Electrical stimulation
— Exercise therapy
— Heat therapy
— Ultrasound therapy
What Are the Costs?
After you have paid the yearly Part B deductible, you will need to cover 20% of the Medicare-approved amount for each chiropractic appointment. If you have a Medigap plan, your out-of-pocket expenses may be lower depending on your plan’s benefits.
If you have a Medicare Advantage plan, the deductible and coinsurance may vary. These plans often have different cost structures, so it’s important to check the details of your specific plan.
Talk with your chiropractor to confirm what will be covered by Medicare. They may recommend further services that will help you improve quicker or more effectively, but you will be responsible for those costs.
Questions to Ask Your Chiropractor
Asking the following questions can help you understand what to expect and what will be involved in your treatment:
— Will you coordinate with my primary care doctor for any X-rays or diagnostic tests that may be needed?
— How many visits do you anticipate I may need?
— What can I do at home to help speed my recovery or help maintain or improve my chronic back pain?
— Will other Medicare-approved therapies like physical therapy be beneficial for me?
— Are there any risks or side effects to treatment that I should be aware of, given my age or health conditions?
[SEE: Top Medications for Back Pain.]
Bottom Line
Back pain affects millions of senior adults and is a leading cause of disability worldwide. Many turn to chiropractic care, which uses hands-on techniques like spinal adjustments along with supportive therapies to relieve pain, improve mobility and promote overall musculoskeletal health. For older adults, chiropractic care can help maintain daily function, support balance and reduce the risk of falls.
Medicare Part B covers chiropractic services only for manual manipulation of the spine to correct a vertebral subluxation, when deemed medically necessary and performed by a Medicare-approved chiropractor. Other chiropractic treatments and diagnostic tests are not covered. Costs include the Part B deductible and coinsurance, and coverage may vary with Medicare Advantage plans. Seniors should confirm coverage with their chiropractor before beginning treatment to understand what services are included and what out-of-pocket expenses they may have to pay.
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Does Medicare Cover Chiropractic Care? originally appeared on usnews.com
