Medicare Prescription Drug Benefit: How It Could Affect Chiropractic Patients

NOTE: ACA has developed a Healthy Living Fact Sheet on Medicare Part C which DCs can use in their practice to alert their patients (members-only).

The Bottom Line
Medicare: What's With All The Parts?



When faced with decisions about other areas of Medicare coverage, chiropractic patients may make choices that will affect their ability to access chiropractic care. The prescription drug benefit is where a lot of the confusion lies.

Beneficiares can access the new drug benefit in one of two ways: 1) by subscribing to a Part D plan or 2) by joining a Part C plan. Subscribing to a stand-alone Part D plan will not affect access to chiropractic care. However, many beneficiaries may decide to move into Part C, which significantly restructures the administration of many of their Medicare-covered services, and does have ramifications for such access.

The Bottom Line

Rumors that Medicare Part B patients will automatically lose their chiropractic benefits if they choose to supplement their existing coverage with one of the many Part D plans are not accurate.

DCs should keep in mind that the real threat to chiropractic access is if a current Part B beneficiary shifts to Part C to access the drug benefit.

DCs who have Medicare patients considering such a change may want to inform them that enrolling in Part C significantly changes the administration of all their Medicare-guaranteed services.

Doctors should advise them to check each of the items on this Healthy Living Fact Sheet (members-only). (If you are not a member of ACA, click here to join online.)


* Government website with general info
* The New Medicare Prescription Drug Benefit: An Overview (a tutorial)
* FAQ on Part D from the Center for Medicare Advocacy
* More info from the Center for Medicare Advocacy [scroll to the bottom for Part D-specific information]

Medicare: What's With All the Parts?
Here's a glance at how Medicare services are divided. Chiropractors generally deal with patients in Part B or Part C.

Medicare Part A: Covers hospital services.
Medicare Part B: Outpatient fee-for-service.
Medicare Part C: Medicare managed care (also known as Medicare Advantage; formerly Medicare + Choice)
Medicare Part D: Includes drug benefit plans administered by various insurers.