Marietta Chiropractor

Medicare + Chiropractic Benefits

In a recent post, we discussed chiropractic benefits with health insurance.  Now we will look at chiropractic benefits with Medicare.

In the state of Georgia, the Medicare part B annual deductible is $187.  The co-payment for Medicare is approximately $40.  All that this covers is the spinal manipulation.  It does not cover extremity adjusting or any physio-therapeutics or health history and exam.  Once the Medicare patient has met their deductible (about 4-5 visits), the patient then pays a 20% co-insurance, so their cost is approximately $8.00 per visit.  As with regular insurance, this is limited to approximately 20 visits per year and must be for acute care only.  Maintenance care is not covered by Medicare.

Should the patient need more than 20 visits, or choose to pay for extra services that are not covered, such as massage or ultrasound, the patient can then elect to sign an ABN – Advanced Beneficiary Notice, where they choose to self-pay and still have Medicare billed; or self-pay and choose not to bill Medicare.

The challenge here is that by the time a person reaches age 65, most of their joints have degenerated, whether spinal or extremity (knees, hips, etc).  Rarely is there a new injury, but rather an acute flare-up of an old injury that needs care.  It took 65 years for the body to wear down at this point, rarely will there be lasting results with only 3 – 4 weeks of care.  This is the number one reason chiropractors state they do not accept Medicare because of limitations in care and such low reimbursement rate for the limited length of time we are allowed to treat a person.  Here’s a little secret… the chiropractor does not have the option to not accept Medicare patients.  (Lightning bolts are now soaring through the sky to shoot me down for telling this trade secret!)

When I worked at Wellstar Healthplace as a massage therapist and yoga instructor, I would recommend chiropractic care to the over 65 population. Their biggest complaint was that they could not find a chiropractor who would accept Medicare benefit assignment.  I promised then, before becoming a chiropractor, that I would offer chiropractic care to the Medicare population because I firmly believe that everyone needs chiropractic care.  We have more people over the age of 65 alive now than ever before in history.  Blessedly so, these Baby Boomers are even more active now than they ever have been in history.  It is a joy for me as a chiropractor to be able to help a grandmother be able to sit on the floor with her grandchildren and be able to play without pain or the fear of getting up from the floor.

If you have further questions about insurance and chiropractic, you need to first reference your insurance company about your personal policy.  Each policy is uniquely different.  You have to ask specifically about chiropractic benefits.  Once you understand your benefits, then you can ask your chiropractor how to best work within the guidelines to have your chiropractic needs met.  I wish I could say that 20 visits per year will be enough for that low back strain you have after doing intense yardwork over the weekend, but sometimes, that is not the case.  Your aches and pains did not happen overnight (unless you had a sudden traumatic injury) and neither will the best chiropractic care cure that pain overnight.  Be sure to check in for other blog posts about chiropractic care and healing times.

Posted in The Empowered Patient Series and tagged , , , , , , .