Medicare Coverage for Chiropractic Care
Pro Chiropractic is a Participating Provider with Medicare and therefore, obligated to follow Medicare policies. Medicare handles chiropractic care differently from other medical healthcare plans. If you have a Medicare Replacement plan, your coverage may differ from traditional Medicare, in which case our staff will be happy to confirm your benefits.
Medicare (MC) will ONLY cover the cost of a spinal manipulation designed to help correct vertebral subluxations. This occurs when the bones in the spinal column lose their normal motions and position causing a multitude of ill effects.
Medical necessity is a requirement for MC to pay for adjustments. Your adjustments must relate directly to your specific health complaint, adjustments must show functional improvements, and you MUST follow your chiropractor’s specific plan for active treatment.
WHAT IS FUNCTIONAL IMPOROVEMENT?
Medicare wants to see restored ability to turn, bend, walk, sleep, and see you preform your daily activities. MC will not judge progress simply by how you feel. Once your improvement stops, then MC coverage will stop. They consider further care to be maintenance and will insist you to self-pay.
YOUR PATIENT RESPONSIBILITY
Regardless of the type of doctor you see, Medicare requires an annual deductible amount to be paid in full before any coverage will start. This annual deductible may change from year to year and our staff will be able to update you on your visit. Once your annual deductible has been met, your responsibility will be a 20% co-payment for the cost of each chiropractic adjustment. Medicare will pay the remaining 80% of medically necessary adjustments.
If you have a Medicare Supplemental Insurance, they may in some cases, pick up the annual deductible and 20% co-payment. Our staff will be happy to verify your secondary benefits.
MEDICARE EXCLUDED SERVICES
• Maintenance Care – MC will NOT pay for any chiropractic care to maintain your progress or to help prevent problems. Unfortunately, NO “tune-ups” will be covered.
• Examinations – MC requires periodical examinations to identify the presence of vertebral subluxations, however, will NOT cover the cost of the exam.
• X-Rays – MC will NOT cover the cost of x-rays at any time during the course of your treatment.
• Adjustments to Extremities and other Modalities- Our doctors will only recommend and provide the care that is clinically appropriate for you, the patient. Treatments regarding the ankles, wrist, soft tissue treatments, etc. will NOT be covered by MC.
HOW MANY VISITS WILL MEDICARE ALLOW?
The number of visits MC allows is based on the severity of the condition being treated. You and your doctor will discuss visit options during your appointment. If more visits are needed outside of what MC will allow, and seem beneficiary to you, you may pay for the care yourself.
PRO CHIROPRACTIC’S PATIENT PROMISE
Dealing with the strict regulations of Medicare can be frustrating. Our promise to all our Medicare patients is to provide the latest information regarding healthcare, answer any questions you may have, make necessary recommendations for further progress, and to provide ways of staying well without the use of drugs or surgery.
From all of us at Pro Chiropractic, thank you for your patronage and we look forward to serving you.