01/16/2017 by GOLDI JACQUES-MAYNES
Medicare Coverage of Chiropractic Care
We know most of our beloved senior patients have Medicare, and that comes with questions about chiropractic coverage. Since we love helping our seniors get the care they need, we wrote this blog post to help explain how we work with Medicare.
Are Chiropractic Services covered by Medicare?
Yes! MEDICARE PART B (MEDICAL INSURANCE) covers manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider. All people with Part B Medicare are covered for chiropractic adjustments. Look at your Medicare Card. If there is a B on it, you’re covered!
Golden Chiropractic is “Non-Participating” with Medicare. What does that mean? How am I covered?
Since we are a “Non-Participating” in-network provider for Medicare, you will have to pay your exam and office visit fees to the clinic up front, at the time of service. Our clinic will submit billing claims to Medicare on your behalf, then Medicare (and/or your supplemental insurer, if you have one) will reimburse you directly for the Medicare-approved amount. This is typically about $25-30 per visit based on our patient reports.
Medicare does not cover your Initial Exam or Re-Exams.
These exams will be your responsibility out of pocket. Initial exams and re-exams are necessary for the doctor to determine your complaint and come up with a treatment plan to help you feel better.
Medicare also does not cover a variety of other essential services (such as Manual Therapy, Therapeutic Exercises, extra-spinal adjustments, Electrical Stim), we include only one of these “non-Covered Services” in any treatment session even if more than one is performed.
How do Deductibles and Coinsurance work with Medicare?
Deductibles are a set dollar amount that a patient will have to pay before insurance starts covering expenses. Your Medicare Part B Deductible in 2024 is $240. This amount resets every year in January, and only the covered portion of your visit will apply to your deductible. You should receive communication from Medicare for each visit showing your Medicare-approved amount, and if it is applied to your deductible or is paid directly to you.
Coinsurance is a percentage of the Medicare-approved amount for a service that the patient will pay out of pocket. All Medicare patients pay a 20% coinsurance of the Medicare-approved amount.
How does chiropractic care work with Medicare supplemental coverage?
If you have Medicare Supplement Insurance, Medicare automatically forwards your claim to them for possible reimbursement. Supplemental Insurance can vary greatly, but generally covers your out of pocket costs for deductibles, co-insurances or Non-Covered Services. You should receive communication from your Medicare Supplement for each visit showing your Medicare-approved amount, what they cover, and how much is paid directly to you.
How do I figure out my actual cost for chiropractic care?
To find out how much your specific service or treatment plan will cost, talk to our staff. In general, fees matching our Self Pay rates ($200 for a new patient exam, $125 for a Re-Exam, $80 for a chiropractic treatment) will be due at the time of visit. Your reimbursement may vary: The specific amount you’ll pay overall will depend on several things, such as your other insurance coverage and how much you have already paid towards your deductible.
How does Medicare differ in covering Maintenance Care vs. Active Care?
Your chiropractor may recommend that you get services more often than Medicare covers. Medicare only covers “Active Treatment” of acute complaints, and does not cover “Maintenance Care,” even if such care is beneficial to the patient. Ultimately, it is up to the doctor to define your treatment plan and clearly explain it to you. It’s important to ask questions so you understand why your doctor is recommending certain treatment intervals and whether Medicare will pay for them.