Medicare may cover some of your chiropractic care

Whether medicare covers chiropractic care is a common cause of confusion, and something I get asked about a lot.

The short answer to this question is - YES - in some cases medicare will cover chiropractic care.

Under the Australian Medicare system, you are entitled to 5 sessions a year under a Chronic Disease Management plan. To utilise this plan, you must be referred to your chiropractor by your GP.

How do you know if you’re eligible?

The eligibility criteria is quite straight forward. You must have a Medicare card, your GP must refer you, and you must have a chronic health condition (lasting more than 6 months).

You can access up to 5 visits with a range of allied health professionals to support your journey back to health - please note this is 5 visits COMBINED - for example it can include visiting your podiatrist, physio or OT - but is limited to 5 visits total, no matter who you see.

Getting a referral for a Chronic Disease Management Plan

Getting a referral is as simple as speaking to your GP. Your GP will need to sign off on your choice of allied health provider, but cannot refuse your choice. They will decide whether your condition qualifies for a chronic disease management referral for you.

Is there any cost associated?

Medicare will pay a rebate towards 5 sessions. Depending on your choice of provider, will determine whether you need to pay a gap payment or not.

Some providers will allow access to this service as a bulk billed service, whereas others will require payment upfront with subsequent Medicare rebate refunded to you.

I personally have a gap payment for my consults, and you are required to pay upfront and input a claim for your Medicare rebate. Chronic disease management rebates are not claimable on the initial consultation.

What chronic conditions are eligible?

Musculoskeletal pains such as neck pain, back pain or disc pain, sciatica, headaches or migraines are all eligible. This is also the case for chronic foot pain, knee pain, arm pain, or arthritic conditions.

A chronic condition is something that has been present for at least 6 months. Even if you are not in pain for 6 months, all degenerative diseases take a long time to develop and therefore qualify, no matter the duration of your pain.

Where do you go from here?

First step is going to your GP and asking for a chronic disease management plan.

Second step is booking an appointment with your chiropractor, or finding one in your area.

Easy as that!