Does Medicare Cover Chiropractic?

Medicare can pay for your chiropractic care

At least once a week a patient will ask us “Does Medicare cover Chiropractic?” 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. This is organised by your GP 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. When you consider 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 and Medicare can help you do just that.

 FIND OUT IF CHIROPRACTIC CAN HELP YOU 

Who’s Eligible?

You are eligible if you have a chronic condition and you have 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 with them 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 the full cost of each of your visits.

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 be 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 actually qualify for this cover.

What conditions are eligible?

Any condition that is chronic and complex is covered by Medicare through the CDM program. The most common conditions that we help on a daily basis are

 

What happens on your first visit?

During your first visit we will do a thorough history and examination of your spine and, if necessary, arrange any x-rays that are needed to find the cause of your problems. These x-rays are fully covered by Medicare so 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. As well as 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 are currently seeing a chiropractor or have never been to the chiropractor before. 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 5 visits that you are entitled to can be used during your ongoing treatment and paid for by Medicare.

What do I do now?

Please leave a comment below if you have any questions we would love to hear from you. Alternatively have a look at the information within this website about what we treat such as low back pain, sciatica, shoulder pain, neck pain or headaches. You will also find many exercise videos to help both improve the flexibility and strengthen your spine.

For more information about chronic disease management and Medicare go to:

http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdisease-pdf-infosheet

Copyright Ansell Chiropractic ©2017

8 Comments

  1. Paul

    Thank you Ansell Chiropractic, this has explained EPC very well. What a great opportunity to access Chiropractic care for our chronic back complaints. The cost to the Australian economy of over $20 billions dollars, pales into insignificance when it comes to the loss of quality of life and enjoyment.

    Reply
  2. Fiona Plant

    Thanks for making it really clear as to who can qualify for an EPC. I have had clients ask their GP for an EPC and they have been told they don’t qualify for it even though they fit the criteria.

    Reply
  3. Kimberlee

    It’s so great how straight-forward and to the point this is. Thanks so much! We have patients come in everyday who are not fully aware of all the benefits that their insurance has to offer. It’s interesting to learn about how Medicare coverage works in Australia.

    Reply
    • daryl

      Thanks for your comments Kimberlee. We really appreciate your support.

      Reply
  4. Vicki Copping

    Thank you so much for this concise information.
    My husband & myself had fantastic chiropractic
    Therapy whilst living in Melb. Now we are so far
    away…..we miss the healthy realignment we certainly
    experienced with Dr. Nemeth. Now we are 11 years older
    72 & 61…….both arthritic……help would be fantastic! 🙏😆

    Reply
    • Ansell Chiropractic

      Thank you for your comment Vicki.
      If you are in Townsville we would love to help you.

      Reply
  5. Rhiana

    Hi, thank you for that information, really appreciated. Just wondering if you have private health will Medicare still cover the small portion I am out of pocket each visit?

    Reply
    • daryl

      Hi Rhiana How it works is that Medicare pays for up to five visits under the CDM medicare program. That is totally separate to your private health fund and you cant use the two together.
      If you have private health cover use this link to have your first visit fully covered by your health fund.
      https://www.ansellchiropractic.com.au/contact/private-health-offer/
      Hope that helps

      Reply

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