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MEDICARE

Medicare is likely to cover at least some of your chiropractic care. This is important because Medicare handles chiropractic care differently from medical treatment. Here’s how to take advantage of your chiropractic benefits under Medicare part B.

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YOUR COVERAGE

Medicare only covers the cost of chiropractic adjustments designed to help correct vertebral subluxation. This is when bones of the spinal column lose their normal motion and position. The resulting nerve involvement can have far-ranging health effects. If you have a Medicare replacement plan, your coverage may differ from traditional Medicare. We will help confirm your benefits.

THE EXAMINATION

An examination is necessary to identify the presence of vertebral subluxations. Medicare requires this. But Medicare does not pay for the cost of the exam or any needed x-rays.

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YOUR RESPONSIBILITY

Regardless of the type of doctor you see, Medicare requires you to pay an annual deductible amount. Then you’ll be responsible for a 20% copayment for the cost of each chiropractic adjustment. Medicare will pay the remaining 80% of the cost of adjustments that Medicare deems medically necessary.

MEDICAL NECESSITY

For Medicare to pay for your adjustments, they MUST be “medically necessary”.

THAT MEANS:

  1. Your adjustments must relate directly to your specific health complaint.

  2. Your adjustments must serve the purpose of making functional improvements.

  3. You must follow your chiropractors specific plan for active treatment.

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FUNCTIONAL IMPROVEMENT

Instead of judging your progress simply by how you feel, Medicare wants you to improve function. That means an improved  ability to turn, lift, bend, walk, sleep and generally perform your daily activities.

Once improvement stops, Medicare coverage stops. That’s because they consider further care to be maintenance care and expect you to self-pay.

MAINTENANCE CARE

Medicare does not pay for chiropractic care to maintain your progress or help prevent problems. While most patients see the benefits of wellness care, Medicare does not pay for it. Recognizing the value of protecting their improvement, many choose to self-pay.

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EXCLUDED SERVICES

We only recommend the care that is clinically appropriate. That might include other procedures such as massage, traction or other therapies. Medicare does not pay for these, nor do they pay for the adjustments to your wrist, ankle, or any extremity. Sometimes these procedures may be covered by any supplemental insurance you may have.
Time of service discounts or membership in a discount medical plan may reduce your out-of-pocket expense.

 

MAXIMUM IMPROVEMENT

The number of adjustments covered by Medicare varies. It’s based on the severity of your complaints. Sometimes more visits will be needed then what Medicare will pay for. If continued care seems appropriate to you and your chiropractor (but not Medicare), you may pay for the care yourself.

 

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OUR PARTICIPATION

Our practice is a Non-Participating Provider with Medicare. That means you’ll pay any unmet deductible amount for the calendar year. You pay the Medicare rate at time of service to us and we bill Medicare. Then, Medicare reimburses you directly the portion of the charges that Medicare is responsible for. 

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