Last week I flipped the table and discussed something that Original Medicare does cover that Medicare Advantage does not: Hospice care. Not to fear, if you have a Medicare Advantage plan and Hospice care becomes necessary, your hospice care will still be covered. It will be through Medicare Part B rather than your Medicare Advantage plan.
This week I am back to what Original Medicare does not cover. This week’s topic is a bit more confusing, chiropractic care. A significant care need where lots of people seek help from chronic pain. My wife just spent several months seeing a chiropractor. The result, a referral to a physical therapist, and she is still dealing with pain. We’re working on it. God willing, we’ll find that light at the end of a painful tunnel.
The rules for chiropractic care can be challenging. They seem to tiptoe in a gray area, so it can be frustrating.
Let me tell you a story…
Last year a client, who I will call Jay, sat in my office and fumed. He raged on me something terrible. Basically, calling me stupid. Not needing his abuse, I kicked him out of my office and suggested he find another agent. But, I do understand his confusion.
So, what was his beef? He said that his chiropractic visits were costing him $20 a visit with his Medicare Advantage plan compared to $8 when he only had Original Medicare. My first response was, “You can’t even buy a Happy Meal for $8.” I don’t think that comment made him feel any better. I have no idea how he was getting treatments for $8. His wife watched with a stunned face as he hurled one insult after another.
Chiropractic Care Coverage with Original Medicare
- Original Medicare does not cover MOST chiropractic services including tests like x-rays. Most! Really? Now that’s confusing.
- Most? Where’s the exception? Medicare Part B pays for manual manipulation of the spine to correct vertebral subluxation, which is basically a partial dislocation of a spinal vertebra from its normal position. However, generally speaking, Original Medicare does not cover chiropractic. It is there to fix a medical issue and is not for elective care.
- Part B has an annual deductible of $226, then a 20% copay. (Still don’t know how that would get Jay’s chiropractic costs to an $8 copay.)
Chiropractic Care Coverage with Medicare Part C (Medicare Advantage Plans)
- Medicare Advantage plans do cover chiropractic to some degree or another. And we already established that Jay was paying $20 a visit.
- Covered supplemental services include:
- new and established patient examinations,
- select x-ray procedures,
- non-spinal/extremity manipulation, and
- select physical medicine modalities and procedures.
- To my surprise, some plans have no limits on how many visits you can make in a year.
Why Should I Use an Independent Agent?
Jay’s wife, a delightful person, called me about six weeks ago. She told me that Jay changed to another plan without the help of an independent agent. Because he did that, he gave up a sure $900 a year benefit, and he still must pay the chiropractor $20 a visit. The funny part is he now wants my help with an issue. Not being his servicing agent can make it very difficult to be able to help him, nor am I under any obligation to do so. Maybe I have a soft heart, or maybe because his wife is a good person, I did what I could to help. That’s just who I am.
As Paul Harvey would say at the end his programs, “now you know the rest of the story.”
P.S.
Original Medicare does not cover acupuncture at all. While many Medicare Advantage plans do cover acupuncture, good luck finding someone in-network.