Does Medicare Cover Chiropractic Care?
In Australia, chiropractic care can be partially covered by Medicare under specific circumstances. Patients with chronic musculoskeletal conditions may be eligible for up to five Medicare-subsidised chiropractic visits per year through a Chronic Disease Management (CDM) Plan, previously known as the Enhanced Primary Care (EPC) program. This requires a referral from a general practitioner (GP).
How Does Medicare Coverage Work?
Medicare does not cover routine chiropractic visits, but through the CDM program, eligible patients can access up to five visits per calendar year to allied health providers, including chiropractors. The process involves:
- Consulting with a GP – Your doctor will assess whether you meet the criteria for a CDM plan.
- Receiving a referral – If approved, your GP will provide a referral for chiropractic treatment. This has a 12 month expiry.
- Using the subsidised visits – The plan allows for up to five Medicare-funded sessions per calendar year depending on your referral, which can be spread across different allied health providers or used entirely for chiropractic care.
Who is Eligible for a CDM Plan?
To qualify for Medicare-subsidised chiropractic care under a CDM plan, a patient must have a chronic medical condition that has been present for at least six months and requires ongoing management. Examples include:
- Chronic back pain
- Sciatica
- Arthritis and joint conditions
- Postural and spinal issues related to long-term musculoskeletal concerns
Your GP will determine whether you meet the criteria based on your medical history and overall healthcare needs.
Are There Out-of-Pocket Costs?
Yes, Medicare provides a set rebate per chiropractic session, which covers part of the cost.
Additional Considerations
- The five services per calendar year are shared across all allied health providers under the CDM plan, so if a patient requires physiotherapy, podiatry, or another service, the visits will be split among these providers.
- CDM plans must be renewed by a GP each year, and continued eligibility is determined by the patient’s ongoing healthcare needs.
- Medicare does not cover routine wellness chiropractic visits—only those related to chronic health conditions under a GP-managed care plan.
- To claim the rebate onsite, a savings or bank card must be used.
Conclusion
Chiropractic care may be covered by Medicare for eligible individuals with chronic musculoskeletal conditions, but access is limited to five subsidised sessions per year under a CDM Plan with a GP referral. Patients should consult their GP and chosen chiropractor to confirm eligibility and any potential out-of-pocket costs.
If you are experiencing chronic pain or a musculoskeletal condition, discussing your options with a healthcare provider can help determine the best course of action.
Contact us today to learn more about chiropractic care and how it may be supported by Medicare or private health insurance.
