Let’s start with private insurance…

A question we get quite often is: “Do you take insurance?”

The short answer: Yes.

The truth? It depends.

Not all insurance is the same… Welcome to the Jungle 😐

Depends? Depends on what?

Well, each insurance provider such as Blue Cross, United, Cigna, etc all operate as a separate entity. And even within those names will be many different groups. Each provider, and each group under that provider have different premiums, deductibles, copays/coinsurances, benefits, and limitations.

So, do we accept your insurance? Sure. But a better plan between the two of us, would be for me to look up the specific plan and benefits your insurance provides you. Then after we gather all the details we can make a decision together on whether billing your insurance or paying out of pocket is the best financial option.

Enter Medicare…

So, if you thought that was confusing, hold on tight, because Medicare can be a bit much to understand.

Okay, that may have been a bit dramatic, in reality, at least in terms of Chiropractic, Medicare is quite simple.

First, the question is no longer “do you accept my insurance?”, it’s more like “are you a provider for Medicare?”. To which we would answer, YES!

Next, everyone on Medicare has a deductible that must be met before Medicare will help with any costs. That varies year to year and we are happy to tell you what that is, and how much you have left to pay when you call in! (See, not so bad so far?)

Then, Medicare will NEVER cover any type of wellness/maintenance/vitalistic whatever you want to call it care. They will cover injuries, pain, and/or dysfunction to the body. Which means, as awesome as Chiropractic is for basic preventative care, Medicare only cares, well… will only pull out the checkbook if you are actually hurt or dealing with actual pain.

Medicare is going to cover diagnosable issues to the spine and no where else. Skull to tailbone, thats it. Your Chiropractor is able to bill for any adjustment made to the spine. But, any extremities (like your shoulders, elbows, wrists, knees, ankles, etc), any physical therapy needed, are not going to be covered and will need to be paid for out of pocket (yeah, I know what you’re thinking).

Question: How do I know if I am wellness or have an actual complaint? And how will I know how many visits and how often to come?

Welcome to the next Medicare hurdle: The Exam.

So, I gave you a list of things Medicare is not going to cover, basically things outside of the spine. And we understand that Medicare is going to ONLY pay for adjustments to the spine. But there is one CRUCIAL step to starting your care, and that is the Initial Exam.

You may be asking, why are you making a big deal about the Exam, of course I would need one to actually see whats wrong with me and for the doctor to tell when what the best course of care would be?

Well, turns out, Medicare would disagree with you and will not be covering the costs for your exam. Which means it is necessary, but also under the list of services not covered by Medicare and will have to be paid out of pocket.

THE GOOD NEWS IS your exam is very affordable, and most offices are willing to work with patients to negotiate an affordable cost for the exam.

So we made it past the exam, and now we are into our care!

You can rest now. This difficult process is over. From here your doctor is going to provide treatment, and submit all the necessary billing to Medicare for you. The only costs you will come across at this point is your yearly deductible if it is not met, your 20% coinsurance on your adjustments, and any charges to be paid out of pocket for non-covered services like physical therapy.

What is Supplemental Insurance?

In many cases, a patient will have Medicare Plan A & B which covers their hospital and doctors visits, but also have a Plan G, or Supplemental plan. This supplemental plan will cover the 20% coinsurance cost for the Chiropractic visit. It doesn’t pay your premiums, deductibles, or non-covered services.

These also vary by plan, so be sure to let us know right away and we can get all of the details prior to you coming for your exam!

We are here to help!

Hopefully this brought some insight into how Chiropractic care and Medicare can work together to help you get some of your care costs covered! But we know that it can be a lot to understand, so if you have any questions, please reach out to us and we would be happy to help!