Medicare Plans and Bones | Kern Valley Sun

Chiropractic services are covered by some of the Medicare Advantage HMO plans. | Unsplash/Toa Heftiba

I had two phone calls regarding physical therapy and chiropractic care. I figured these would be good topics this week.

I don’t know if it was a strong lobby by the AMA or some other reason, but “Original Medicare” Part B has never fully covered chiropractic care. Chiropractic care is covered if the chiropractor is a Medicare provider. Per Medicare.gov, “Medicare Part B (Medical Insurance) covers manual manipulation of the spine by a chiropractor or other qualified provider to correct a vertebral subluxation (when the spinal joints fail to move properly, but the contact between the joints remains intact) .

Medicare doesn’t cover other services or tests a chiropractor orders, including X-rays, massage therapy and acupuncture (unless the acupuncture is for the treatment of chronic low back pain). Note, that X-rays taken by the chiropractor are not covered, but if taken by a radiologist, they probably are covered.

However, chiropractic services are covered by some of the Medicare Advantage HMO plans. This past week, George informed us that he is seeing a chiropractor, as he injured his back in a fall. It is currently being covered by the liability policy of the company where the fall occurred. However, his HMO plan does not cover chiropractic care and the liability policy will not cover ongoing treatments. George is on Medicare and Medi-Cal, and therefore, he can change plans once each of the first three quarters of the year. We placed him in a plan that will provide him with 30 visits once his liability-covered policy terminates treatment.

Andy called with a physical therapy (PT) issue. Recent changes from a few years back now have Medicare providing medically necessary outpatient PT with no limit on the number of visits providing it is recommended by a doctor or other health care provider. The key is “medically necessary.” My understanding is that Andy feels he needs more, and the doctor is willing to order more, but the physical therapist knows that Andy doesn’t meet the “medically necessary” criteria. If a claim is filed, Medicare might pay. However, after the two-year backlog on Medicare’s claims review, the therapist believes he will be rejected, and payment would be charged back to him. Friend or no friend, he doesn’t want to get in trouble with Medicare. Now, Andy just had a knee replaced, and this is a new treatment, and this will be covered.

Here is a case where if George had Original Medicare and a Supplement, he would not have had a problem. A Supplement is out of the financial means, so he is justifiably on a Medicare Advantage plan. He just was not on a plan I would have ever recommended.

Andy on the other hand is fortunate he is on Original Medicare with a supplement, as the chances are his PT would have been denied after “so many” treatments.

I guess we can say, it is best to “plan ahead.” One person, who can afford most anything, needed her arm twisted to get a Supplement plan as she is now turning 65. She tells me she is in great health and hardly ever sees a doctor. I chuckle to myself as I’m writing this. Andy said about the same thing in 2001 when he was in good health as a new Medicare beneficiary. Now he is thankful, as he couldn’t qualify for a Medicare Supplement with his health history over the past 5-6 years.

Harry P. Thal, the Medicare Guru in Kernville, is available for free phone consultations. Call 760-376-2100 or 800-498-8425 for a phone appointment or send an email to harrythal@aol.com.

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