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Medicare Coverage of Neck and Back Pain


Summary:  Medicare may cover diagnostic tests, surgery, physical therapy, and prescription drugs for back and neck pain. In addition, Medicare Advantage plans may cover wellness programs to help back and neck pain. Medicare generally doesn’t cover chiropractic care.

Neck and back pain in the United States

If you experience back and neck pain, you’re not alone. According to a recent Gallup study, neck and back pain is extremely common in the U.S. In fact, one quarter of Americans have seen a health care provider for back and neck pain in the last year.

When it comes to treatment, most patients see medical doctors (62%) or chiropractors (53%), followed by physical therapists (34%) or massage therapists (34%). According to the study, one in four patients prefer not to be treated by surgery or prescription drugs.

Does Medicare cover neck and back pain diagnostic tests?

Because the cause of your neck and back pain can vary, one of the first things your doctor may do is run tests to try to find the source. Medicare may cover medically necessary diagnostic tests your doctor orders.

According to the Mayo Clinic, diagnostic tests may include:

  • Imaging tests like MRI or CT scans
  • X-rays
  • Blood tests to check for infection
  • Electromyography (EMG) to test nerves
  • Bone scans (see below)

Sometimes, your doctor may order a bone scan to check for fractures. Medicare may cover these tests in some cases, especially because conditions like osteoporosis can increase your risk for fractures in your spine.

Does Medicare cover neck and back pain treatment?

According to the Mayo Clinic, most neck and back pain can be treated at home with self care. This might include gentle stretching; warm and cold compresses; and over-the-counter pain medications. But if you’re having ongoing pain that doesn’t go away, talk to your doctor about other treatment options that may help you.

Medicare may cover medically necessary treatment to treat neck and back pain, such as:

  • Surgery
  • Physical therapy
  • Doctor visits
  • Prescription pain medications

According to the Mayo Clinic, certain conditions like arthritis and cancer may also cause neck and back pain. So, working with your health care team to manage these conditions may help your neck and back pain as well.

Does Medicare cover medications I need for my neck and back pain?

According to the Gallup study, most people with neck and back pain take over-the-counter medications. Over-the-counter drugs aren’t typically covered by Medicare, and you’ll generally have to pay out of pocket. However, if your pain is severe, your doctor may prescribe pain relief medications, which may be covered by Medicare Part D. Medicare may also cover muscle relaxants or cortisone injections if your doctor prescribes them for your neck and back pain.

What are my risk factors for neck and back pain?

According to the Mayo Clinic, you’re more likely to have back and neck pain as you get older. However, regular exercise and strengthening may prevent you from getting injured. Weight lifting can help you get stronger so you’re less likely to get hurt. Obesity can also be related to back pain, so it’s important to stay active. Some Medicare Advantage plans cover wellness programs for older adults. These fitness benefits are sometimes offered as an extra benefit, in addition to what’s normally covered under Medicare Part A and Part B.

Smoking also increases your risk for neck and back pain, according to Mayo Clinic. This is because smoking can block blood flow to your spine. If you’re a smoker, Medicare covers smoking cessation counseling to help you quit.

What Medicare doesn’t cover for neck and back pain

Medicare doesn’t cover all treatment options. This includes:

  • Most chiropractic services
  • Acupuncture
  • Massage therapy
  • Yoga
  • Over-the-counter medicine

According to the Gallup poll, over half of patients use chiropractic services for neck and back pain. Unfortunately, Medicare coverage for chiropractic care is limited. Medicare may cover chiropractic services for manual manipulation of your spine. This may be covered when it’s done to fix a subluxation, which is when a bone in your spine shifts out of place. Medicare generally doesn’t cover other types of chiropractic services.

Medicare doesn’t cover other alternative therapies like massage, acupuncture, or yoga. Keep in mind that you pay the full cost for what Medicare doesn’t cover.

If you’re ready to start browsing Medicare plan options for Medicare Advantage or Medicare Part D to cover back pain, just enter your zip code on this page.

Source: Gallup

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