If you’re a Medicare recipient in Walnut Creek considering chiropractic care, it’s essential to know what’s actually covered, what your out-of-pocket costs might be, and where the restrictions lie.
At Elite Chiropractic Rehab and Wellness, we work with Medicare patients every day, many of whom arrive unsure about how their visits will be billed. This guide will walk you through how Medicare handles chiropractic coverage, what you’re expected to pay, and what limitations to be aware of.
What Does Medicare Cover for Chiropractic Care?
Original Medicare (Part B) offers limited coverage for chiropractic services, specifically for spinal manipulation to treat a diagnosed subluxation. A subluxation refers to a misalignment of the spinal vertebrae that causes pain or reduced function.
Here’s what’s included:
- Manual spinal adjustments to treat active spinal subluxations
But there’s a catch: Medicare does not cover the initial exam, diagnostics (like X-rays), or additional therapeutic services such as muscle stimulation, decompression therapy, or laser treatments. Only the spinal adjustment is reimbursable.
If your treatment includes anything beyond spinal manipulation, you’ll likely need to pay for those services out of pocket, unless you have supplemental or Advantage coverage.
Understanding Copays and Out-of-Pocket Costs
Under Original Medicare, you pay 20% of the Medicare-approved amount for each chiropractic adjustment after meeting your annual Part B deductible. Medicare pays the remaining 80%.
Here’s what that could look like:
- Medicare-approved amount for spinal adjustment: $30–$50 (varies by location/provider)
- Patient responsibility: ~$6–$10 per visit after deductible
Keep in mind:
- Initial consultations and exams are not covered under Original Medicare.
- If you’re receiving other forms of therapy (even within the same appointment), you will pay for those separately.
At Elite CRW, we explain all costs up front and help you understand which services are covered and which aren’t, so you can make informed decisions.
Restrictions You Should Know
Medicare’s chiropractic coverage comes with a few important limitations:
- Coverage Only Applies to Active Treatment
Medicare covers chiropractic adjustments only if they’re part of an active treatment plan. That means there must be a reasonable expectation of improvement. - No Coverage for Maintenance or Preventive Care
If your condition has stabilized or you’re visiting for general wellness or maintenance, Medicare will not reimburse for that care, even if it’s the same adjustment. - You May Be Required to Sign an ABN
If it’s unclear whether Medicare will cover a service, you may be asked to sign an Advance Beneficiary Notice (ABN). This form acknowledges that you understand and accept responsibility for the potential cost.
These restrictions can be confusing, which is why we guide every Medicare patient through the process step by step.
What About Medicare Advantage Plans?
Medicare Advantage (Part C) plans often offer broader chiropractic coverage than Original Medicare. These plans are provided by private insurers and may include:
- Coverage for exams and re-evaluations
- Imaging like X-rays
- Additional therapy modalities
- More frequent or ongoing visits
- Lower or no copays
If you’re enrolled in a Medicare Advantage plan, bring your insurance card with you. Our team will verify your chiropractic benefits and explain your plan details clearly.
How Elite CRW Supports Medicare Patients
At Elite Chiropractic Rehab and Wellness, we’re committed to providing Medicare patients with high-quality care and full transparency. When you visit us, we will:
- Verify your Medicare or Advantage plan benefits
- Clearly explain covered and non-covered services
- Help you understand your copays or financial responsibilities
- Customize a care plan based on what’s medically necessary and billable
We also offer affordable cash rates for services not covered by Medicare, so you never have to go without care due to coverage limitations.
Final Thoughts
Medicare does cover chiropractic care, but it comes with important boundaries. Understanding what’s included, what your share of the cost is, and where restrictions apply can help you avoid frustration and make better choices for your health.
At Elite Chiropractic Rehab and Wellness in Walnut Creek, we make it easy to navigate Medicare. Whether you’re dealing with a new condition or managing chronic pain, we’re here to help you get the care you need, confidently and clearly. Book your appointment today or call us to verify your Medicare benefits.
