Humana Medicare Advantage 2025 Chiropractic Coverage
The ICS explains that in 2025, Humana Medicare Advantage will continue covering chiropractic care for acute and chronic conditions but will stop covering routine maintenance care. Watch the video to learn more!
Transcript:
We hope everyone is having a fantastic week and a great October. We’re getting a lot of phone calls lately of people who are concerned because they have patients coming in who have the Humana gold plan for Medicare Advantage. So the Humana Medicare Advantage gold plan, or one of their plans, and they’re coming in and showing them that they received a document that shows that they’re going to lose their chiropractic coverage in 2025. We want to make sure that you have all of the information so you can actually provide that information to your patients.
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First of all, I want to ease everybody’s mind that it is probably not as bad as what it seems like on the surface. So here’s an example. I’m going to share my screen here and show you what those documents that the patients are receiving and what they look like in regards to the chiropractic coverage. So here, what you will find is you’ll see this document, and this is an example of one that we’ve gotten from one of our doctors who had a patient bring it in. And you’ll see, under chiropractic services, this year, is zero copay for routine chiropractic visits, up to 12 visits per year. Next year, it’s not covered. You’ll see, this is column, 2024 this is 2025 and this is what’s raising the concern of the patients, and, of course, for our doctors. But I want to provide you with a bit more information to help you understand that it’s again, it’s not this bad. Chiropractic coverage is not going away. Number one is they have to actually offer chiropractic coverage for spinal manipulations because that is what Medicare offers. So because Medicare offers spinal adjustment coverage for patients, in those cases, Medicare C or Medicare Advantage plans must actually offer those same services. They can have other things that they require, such as prior often things along those lines. But in this case, we’re not eliminating all of chiropractic coverage, and let me show you why that is.
So, first of all, let me call your attention to a couple of key details. One is for each routine visit, and this is a $0 copay for routine chiropractic visits. So let’s look at what does this plan look like. And so if we jump over to this specific plan that this doctor sent over, you can actually see, and I’ll zoom in just a smidgen here, you’ll see that they actually list two different chiropractic services that they cover. One is here it is, co-payment for Medicare-covered chiropractic services. This would be spinal adjustments. It goes on to say co-payment for routine care is zero. So they’re listing two different co-pays, even though they’re the same, as far as the dollar amount, two different co-pays in their book of coverage, and this is 2024 book, just so you’re aware, and so you’ll see you have Medicare-covered chiropractic services and routine care. The word that Medicare uses that CMS uses, and many of these Medicare Advantage plans use for maintenance care, is the word routine. So they’re equating routine with maintenance. And so it’s like in Medicare Part B, maintenance care is not covered, or routine care is not covered. Instead, you get covered for acute and chronic conditions, as long as the patient has not achieved MMI, you get those visits, and that’s where the AT modifier comes in. So you’ll see right here under their plan.
These are the two different segments, and if we jump back then and look at the change document, you’ll see again, right here the second listed services co-pay. CO payment for routine care is zero. And you’ll even see in the bullet point, maximum. Tell 12 routine care every year. So it gives you that maximum of 12. We jump back over to the change document right here in the middle, you’ll see for routine visits and routine visits up to 12 in this year, and then in this year, next year, it’s not going to be covered. So what they’re saying is, next year we’re not going to pay for maintenance care, but they are going to continue to pay, as you’ll see in this book, they’re going to continue to pay for CO payment of Medicare-covered chiropractic services or spinal manipulations with an AT modifier, or spinal manipulations for acute and chronic conditions. So we wanted to clear that up. Hopefully, that arms you with the information that you need for your patients to help them understand that they are going to continue to have coverage next year, but they’re not going to have coverage for maintenance care.
From what I’ve been told from a number of our doctors, they struggled actually getting paid under this under these plans, under these human plans, that were negatively impacted with this change, they were struggling getting paid for those routine visits or that maintenance care anyway, but they did not struggle getting paid for those at modified claims, or those chronic and acute conditions where the patient presents and you have a treatment plan and they’re not under maintenance care. So we believe that you’re still going to have coverage from all of the information that we have an additional clarity as we begin to look at all of the Humana documents you’re going to have, they’re going to have coverage next year. Hopefully, this helps you out and helps you explain it to your patients, we will catch you next week.
