The U.S. government offers three different insurance programs that are available to certain populations. Medicare is available to people over age 65, as well as some younger people with certain disabilities. Medicaid covers people with limited income or resources. Tricare covers military personnel and their families.
Most traditional medical treatments and services are covered by these insurance plans. However, coverage for complementary medical treatments such as chiropractic care is not guaranteed. Each of these government plans have different practices when it comes to coverage for chiropractic care.
If you have a subluxation of the spine and a manual manipulation is deemed medically necessary to treat it, the manipulation is covered under Medicare Part B. However, the deductible applies, and you are also responsible for paying 20% of the Medicare-approved amount.
It is worth pointing out that Medicare only covers spinal manipulation. It does not cover other services that a chiropractor may provide, such as acupuncture or massage therapy. A chiropractor will often perform x-rays to diagnose a subluxation, but tests such as these are not covered by Medicare as part of chiropractic treatment.
Though a federal program, Medicaid is administered by the states. Therefore, Medicaid coverage for chiropractic care depends on where you live. In some states it is not covered at all. In others, it is covered, but there is a limit on the number of visits that Medicaid will pay for. Similarly, some states charge a copay, while others do not.
According to a 2018 survey, 21 states (including the District of Columbia) did not include chiropractic care in Medicaid coverage, while 24 did. Of those 24 that cover chiropractic care, 18 impose limits on services and 13 require a copay. The remaining six states did not report one way or the other.
Tricare insurance does not cover chiropractic care. This means that military retirees and family members who desire chiropractic treatment must pay for it out of their own pockets. However, active duty personnel can receive covered chiropractic services at designated military hospitals and clinics through the Chiropractic Health Care Program. Activated National Guard and Reserve members are eligible for this program, but dependents, survivors, and retirees are not. Furthermore, services are only covered for active service members if a primary care manager deems it medically necessary.
There have been rule changes proposed that would include coverage for complementary treatments like chiropractic care and acupuncture under Tricare. In the future, chiropractic coverage may be available to all beneficiaries. However, even if approved, this is unlikely to take effect until 2021 at the earliest.
A good chiropractor, like a chiropractor in Mesa, AZ, will be happy to answer any questions you have about your insurance coverage. If necessary, he or she may be able to work out a payment plan or other financial arrangement with you.
Thanks to LifeCare Chiropractic for their insight into getting chiropractic care with government insurance coverage.