Does Medicare Cover Chiropractic Care?
Does Medicare Cover Chiropractic Care? At least once a week, a patient will ask us, and we are happy to tell them that the answer is yes. As part of your Medicare coverage, you are entitled to up to five chiropractic visits a year, fully paid for by Medicare. Your GP organises this through a Chronic Disease Management plan (CDM) or Team Care Arrangement (TCA). This coverage can save you over $250 in health care costs. Unfortunately, many people who are eligible for this plan don’t even know that they are. If you are suffering from problems such as neck pain, low back pain, sciatica or headaches, make sure that you take advantage of this opportunity to improve your health. Considering that the cost of back pain to the Australian economy is estimated to be over 20 Billion dollars, you realise how important it is that all Australians look after their spines. Medicare can help you do just that.
Are you eligible?
You are eligible if you have a chronic condition and a Medicare card. Your GP will create a specific chronic disease management (CDM) plan for you, and they can then refer you to a chiropractor on a team care arrangement (TCA) for up to 5 visits.
How do I get a referral?
First, you will need to consult your GP about your specific conditions and discuss your eligibility for chiropractic care under a CDM plan. If you are eligible, your GP will send us your TCA referral, and we can then make a time for you to come in for your first visit.
Is there any cost to me at all?
No, there is no cost to you at all. At the time of each visit, we bulk bill the cost to Medicare, and we guarantee that there won’t be any gap fees or hidden charges to you. This means that Medicare will cover your visits’ full cost.
What is a chronic condition?
A chronic condition is defined as a condition that has been present for six months or longer. It’s important to remember that while you may be suffering from acute low back pain, neck pain or a headache that has only been present for a few days, often the underlying cause is a chronic problem that you are not aware of. This is why many acute pain problems do qualify for this cover.
What conditions are eligible?
Medicare covers any condition that is chronic and complex through the CDM program. The most common conditions that we help with daily care
- Low back pain
- Neck pain
- Headaches
- Sciatica
- Bulging and Prolapsed Disc Injuries
- Shoulder pain
- Knee pain
- Repetitive strain injuries (such as a carpal tunnel or tennis elbow)
- Arthritis/ Degenerative Joint Disease
What happens on your first visit?
During your first visit, we will thoroughly examine your spine and, if necessary, arrange any x-rays needed to find the cause of your problems. Medicare fully covers these x-rays, so that you will have no out-of-pocket expenses. On this webpage, you will also find a complete description of what happens on your first visit and demonstrations of what is involved in a neck examination and a low back examination.
What if I am already seeing a chiropractor?
The same conditions apply regardless of whether you currently see a chiropractor or have never been to the chiropractor. Medicare will pay for up to 5 of your ongoing visits with your chiropractor following the referral from your GP. If you are currently seeing a chiropractor, the five visits you are entitled to can be used during your ongoing treatment and paid for by Medicare.
What do I do now?
Please comment below if you have any questions; we would love to hear from you. Alternatively, look at the information on this website about what we treat, such as low back pain, sciatica, shoulder pain, neck pain or headaches.
For more information about chronic disease management and Medicare, go to:
Why is it that my GP won’t give me 5 chiropractic visit. She insists that one or 2 of them has to be for a physio which I don’t want.
Hi Elmarie, sorry to hear that you are frustrated. The GP has the ability to allocate the visits as they see fit, this may be to one allied health provider (e.g. all 5 visits to a chiropractor or physio) or between multiple providers. In my experience, some GPs think that there must be two or more allied health providers used for the referral to be valid. This is not the case. It would be best to take it up with your GP.