In Medicare and You Handbook 2023, the Centers for Medicare and Medicaid Services (CMS) states:

“Chiropractic services
Medicare covers manipulation of the spine by a chiropractor to
correct a subluxation (when the spinal joints fail to move properly, but
the contact between the joints remains intact). You pay 20% of the
Medicare-approved amount. The Part B deductible applies.
Note: Medicare doesn’t cover other services or tests a chiropractor orders,
other than manipulation of the spine.”

Yes, Medicare covers some chiropractic services. However, while the science of chiropractic has progressed, Medicare chiropractic coverage hasn’t been expanded since 1972 and is limited to manipulation of the spine when necessary to correct a subluxation. A subluxation has been described by Medicare as, “When one or more of the bones of your spine move out of position”.  The subluxation must be associated with a symptomatic muscular and skeletal condition, for example, low back pain, disc herniation, sciatica, neck pain, etc. Medicare does not cover preventative chiropractic care. There is an effort by the American Chiropractic Association to achieve Medicare parity through the Chiropractic Medicare Coverage Modernization Act (H.R. 2654).

In my experience most Medicare patients also have a supplemental plan. The supplemental plan almost always only covers the Medicare annual deductible and 20% coinsurance. Medicaid will not pay if it is secondary. Medicare Advantage plans generally follow Medicare coverage but may have a higher copay.

The bottom line is that Medicare helps pay some of the cost of chiropractic services but does not cover any other chiropractic services, such as evaluation, any necessary x-rays, extremity adjustments, massage, or physiotherapy modalities (electrical stimulation, ultrasound, cold laser, traction, decompression), orthotics, etc. In my opinion, services not covered by Medicare are usually needed to provide appropriate patient care and get a good outcome. Most Americans can easily afford chiropractic services and chiropractic care may take the place of more costly and invasive procedures.

Greenville chiropractor Dr. Luke Henry has been a participating provider in Medicare since 2006. He has been a postgraduate speaker at chiropractic colleges, for the South Carolina Chiropractic Association, and has presented at medical and public health conferences. Dr. Henry is credentialed as an expert witness for the Office of Medicare Hearings and Appeals.

Reference

https://www.medicare.gov/coverage/chiropractic-services.html

Q: What are the Chiropractic Benefits for South Carolina State Health Plan?

A: Greenville Chiropractor Dr. Luke Henry has been a preferred provider for South Carolina State Health Plan (Blue Cross Blue Shield) since 2006. BlueCross BlueShield of South Carolina (BlueCross) is the third-party administrator for the State Health Plan. Here are the benefits, taken from SC PEBA’s website at https://peba.sc.gov/

There are two options for state employees, the Standard Plan and the Savings Plan.

The in network benefits are as follows:

SHP Savings Plan

Annual Deductible: • Single: $3,600 • Family: $7,200

Coinsurance: • Plan pays 80% • You pay 20%

• Excludes deductible

Physician Office Visits (In Network): • No copayment
• Plan pays 80% • You pay 20%
• Chiropractic payments limited to $500 a year, per person

SHP Standard Plan

Annual Deductible: • Single: $490 • Family: $980

Coinsurance: • Plan pays 80% • You pay 20%

Physician Office Visits: • $14 copayment
• Plan pays 80% • You pay 20%
• Chiropractic payments limited to $2,000 a year, per person

Patients with the Savings Plan, a high deductible plan, are eligible for a health savings account (HSA). HSA funds may be used for the services at our office and can help you save on taxes. For more information, visit: https://www.irs.gov/publications/p969/index.html

For an appointment, call Dr. Henry’s office at 864-288-7797.

We will be glad to check your benefits and file insurance on your behalf. Dr. Henry also accepts Medicare, Cigna, United Healthcare, Medcost, Aetna, auto accidents, and most insurance plans. Dr. Henry has been recognized for consistent, best-evidence practice: “Tier 1 Advantage” for Optum and “Center of Excellence” status for Health Network Solutions.

Dr. Luke Henry, Chiropractic Physician

Dr. James Levine, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative and the inventor of the treadmill desk has studied the effects of sedentary lifestyle and has coined the phrase, “Sitting is the new smoking”. Evidence suggests that sitting too much increases risk of obesity and many chronic diseases like heart disease, diabetes and some cancers. Dr. Levine went so far as to say, “Sitting too much kills”. As a chiropractor, I see many patients with neck, shoulder and back pain caused by prolonged sitting. Sitting at a computer all day or extensive driving can lead to poor posture, chronic muscle strain and may accelerate degenerative changes in the discs of the spine. The intervertebral discs, the “shock absorbers” between the bones of the spine need movement to stay healthy. I frequently recommend a standing desk as an option for my patients, along with therapeutic exercises to improve posture and relieve repetitive stress. Stretching and adding movement throughout the day helps relieve aches and pains and increases productivity. If you need help with neck pain, back pain, disc problems or an auto accident injury, call my office for an appointment at 864-288-7797.