The answer to that question is yes, but only in a limited capacity. A federal law that passed in 1974, included chiropractic care with Medicare Part B. As a result, Medicare will only cover spinal manipulation, but only when it is deemed medically necessary to correct a subluxation (when your spine is out of alignment). It will not cover the initial exam, nor will it cover physical therapy modalities.
Unfortunately, many patients don’t really understand how Medicare works. It doesn’t pay for everything and, to make matters worse, Medicare cards offer no real information. Depending on which Medicare and/or Medicare Senior plan they are on, some patients have deductibles and co-pays, while others do not. Also, some insurance companies consider chiropractors specialists, rather than primary care physicians, which means the co-pay is often much higher.
The only way to find out what is and isn’t covered, is for the patient to call their insurance company and ask for their chiropractic benefits. A chiropractor will not have access to that information, that’s why it’s a good idea to know what your Medicare or Medicare Senior plan covers before making an appointment.
Let’s say you do know what your Medicare plan covers, but the deductible or co-pay is prohibitive, does that mean you can just opt not to use it and instead go the cash route? Yes, but that can be much more expensive for the patient. Medicare considers it insurance fraud if any health care provider working with Medicare patients does not bill Medicare.
Every treatment must be reported to Medicare, whether it is billable or not and, just as with the IRS, a chiropractor’s books can be audited at any time. As a result, many healthcare practitioners don’t want to provide care for Medicare patients. The philosophy at Pro-Active Chiropractic, however, is to take care of everybody, no matter what the reimbursement rate. If we take good care of grandma, the rest of the family will remember that.
The good news is changes may be coming due to legislation. During the 115th Congress (2018 – 2019), HR 7157 was introduced in the U.S. House of Representatives to provide Medicare coverage “for all chiropractic services within the scope of their license.” Called the “Chiropractic Patient’s Freedom Of Choice Act,” the bill had the support of the American Chiropractic Association (ACA), but it died when it did not receive a vote.
Not to be deterred, in the 116th Congress (2019 – 2020) “The Chiropractic Medicare Coverage Modernization Act” was introduced as HR 3654. This bill “would allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging and utilization of other non-drug approaches…”
According to the ACA’s website, “While the 116th Congress ended before action was taken on the bill, as the 117th Congress begins in January 2021, ACA’s government relations team is working to ensure that the bill will be reintroduced. The new bill will have a new number but will benefit from the momentum gained during the past 18 months.”
All of which underscores the need to find out what you can utilize about your Medicare coverage, before calling a chiropractor. We look forward to the day when this isn’t necessary, but for now it will save a lot of time later on down the line.