How Do the 2027 Medicare Advantage Changes Affect Chiropractic Billing?
The 2027 Medicare Advantage changes are a wave of plan exits, network shifts, and supplemental benefit cuts that take effect January 1, 2027. As of October 2026, nearly 3.2 million enrollees must choose new plans, PPOs are shrinking as HMOs grow, and chiropractic is among the supplemental benefits being cut, so practices face January eligibility, network, and authorization changes for many Medicare Advantage patients.
- What stays the same: Medicare Advantage plans must still cover Medicare-covered spinal manipulation, billed with CPT 98940 to 98942.
- What changes: Plan IDs, networks, referral rules, and routine chiropractic extras may all differ on January 1.
- What to do now: Flag every Medicare Advantage patient and re-verify coverage before the first January visit.
What Changed for Medicare Advantage in 2027
Medicare’s annual enrollment period opened on October 15, 2026, and runs through December 7. The 2027 plans tell a mixed story. CMS described the 2027 Medicare Advantage program as stable, but the plan-level data shows significant churn underneath.
On October 15, CNN reported that nearly 3.2 million Medicare Advantage enrollees, almost 11%, must shop for new coverage because their insurers are no longer offering their plans, citing Medicare Market Insights. Humana alone is discontinuing plans that cover roughly 600,000 members.
HealthWorksAI’s analysis of the CMS 2027 plan files, published October 7, adds the detail that matters for chiropractic practices:
| Measure | Change for 2027 | Why it matters for chiropractic |
|---|---|---|
| Total Medicare Advantage plans | 5,558, down 34 from 5,592 | Fewer choices push patients into new plans |
| PPO plans | Down 89 | Fewer out-of-network options for patients |
| HMO plans | Up 69 | More network limits and referral rules |
| Counties losing at least one carrier | 1,150 | Patients in those areas must switch plans |
| Supplemental chiropractic | Among the largest benefit cuts, behind meals and transportation | Routine visits may become patient-pay |
Insurers are pulling back where costs have risen. Healthcare Brew reported on October 16 that UnitedHealthcare focused its 2027 cuts on PPO plans, as described on the company’s October 13 earnings call. For chiropractic offices, every one of these shifts lands on January 1.
The carrier mix is changing as well. HealthWorksAI found Devoted Health adding 313 plans while Centene, HCSC, and Molina each cut 29% to 48% of their plans, and special needs plans now make up 35% of all Medicare Advantage plans, up from 26% in 2025.
Which Chiropractic Practices Are Affected Most?
Practices with a large Medicare Advantage share are affected most, especially those in counties where carriers exited, those outside the networks of growing HMO plans, and those that rely on routine chiropractic supplemental benefits. Any patient whose plan ended will arrive in January with a new card, a new network, and possibly new rules.
Geography matters. HealthWorksAI found that payers exited nearly twice as many counties as they entered for 2027, with Texas showing the largest net loss. In Minnesota, carriers made 144 county exits and no entries. Practices in markets like these will see the most plan switching.
Network status matters next. The shift from PPOs to HMOs means fewer patients can see an out-of-network chiropractor and still get coverage. A practice that was in network with a patient’s 2026 PPO may be out of network with the patient’s 2027 HMO.
Special needs plans add another wrinkle. HealthWorksAI counted 754 chronic condition special needs plans for 2027, up 35.6%, while dual eligible plans dipped 3.0% to 1,052. Patients moving into these plans often face different networks and care coordination rules than they had in a standard plan. Practices in rural counties should also expect patients whose only remaining carrier is unfamiliar to the front desk.
One question we hear constantly from practice managers this time of year is whether they need to re-verify patients who say nothing has changed. The safe answer for 2027 is yes, because many patients will not realize their plan ended until a claim is denied.
Why Plan Changes Hit Chiropractic Claims First
Chiropractic care often involves multiple visits in the first weeks of a treatment plan, so a single unverified plan change can generate several denied claims before anyone notices. Specialties that see patients once a quarter discover a coverage problem on one claim; chiropractic offices can discover it on ten.
Coverage rules also split in two. Medicare Advantage plans must cover everything Original Medicare covers, which for chiropractors means manual manipulation of the spine to correct a subluxation, billed with CPT 98940 to 98942. Anything beyond that, such as routine visits, extra visit allowances, or extraspinal care, is a supplemental benefit that each plan decides whether to offer. That optional layer is where plans are cutting.
Notice rules differ too. The Advance Beneficiary Notice applies to Original Medicare, not Medicare Advantage. For Medicare Advantage patients, plans use their own pre-service organization determination process, so a practice that relies on an ABN to shift liability to a Medicare Advantage patient may end up absorbing the cost.
The signal for practices is that Medicare Advantage verification is no longer a once-a-year formality. With fewer PPOs, more managed networks, and leaner supplemental benefits, each plan’s specific rules matter more than the Medicare Advantage label on the card.
Dual eligible patients add a Medicaid layer. Federal rules bar providers from billing Qualified Medicare Beneficiaries for Medicare cost sharing, including in Medicare Advantage, so a coordination error with a dual eligible patient becomes a write-off rather than a patient balance. Verifying dual status matters as much as verifying the plan.
What Does the Medicare Advantage Shift Mean for January Claims?
In practice, it means a share of January claims will go to plans that no longer cover the patient or no longer include the practice in network. Those claims typically come back denied for terminated coverage or missing authorization, and the practice learns about the problem weeks after the visits.
Consider a practice with 30 Medicare Advantage patients whose plans end on December 31, each seen 6 times in January. That is 180 visits. At the 2026 Medicare national office rate for CPT 98941, $38.41, those visits represent about $6,914 in claims at risk if no one re-verifies coverage. Medicare Advantage plans set their own rates, so the real figure varies, but the timing problem does not.
For reference, the 2026 Medicare national office rates are $26.72 for CPT 98940, $38.41 for 98941, and $49.77 for 98942, based on CMS’s 2026 Physician Fee Schedule relative value units and the 33.4009 conversion factor.
The denials themselves follow patterns. Claim adjustment reason code 27 signals expenses incurred after coverage terminated, and code 197 signals that a required authorization was absent. A practice that sees either code climbing in January has a verification gap, not a coding problem.
Patients feel it too. A routine chiropractic allowance that disappears in 2027 turns covered visits into patient balances, and patients who did not expect those bills are slower to pay. Practices that explain the change before January, and collect at the time of service where appropriate, avoid a backlog of small balances that cost more to chase than they are worth.
How to Prepare Your Chiropractic Billing Before January 1
Work through these seven steps between now and the first full week of January 2027:
- Pull a list of every Medicare Advantage patient. Include the plan name, member ID, and whether the plan is a PPO, HMO, or special needs plan.
- Ask patients about plan changes during fall visits. Enrollment runs through December 7, so a quick question at checkout catches most switches early.
- Re-verify eligibility before each patient’s first January visit. Confirm the new member ID, payer ID, network status, and visit limits.
- Check network participation with every new plan. Confirm whether the plan manages chiropractic through its own network or a specialty vendor.
- Confirm referral and authorization rules. HMO plans may require a referral or prior authorization before chiropractic visits are covered.
- Update financial policies for services losing coverage. Use the plan’s pre-service organization determination process rather than an ABN.
- Monitor January denials daily. Watch for reason codes 27 and 197, and correct the patient’s coverage record the same day.
Documentation habits still apply. Medicare-covered spinal manipulation under a Medicare Advantage plan still needs clear subluxation documentation and evidence of active, corrective treatment, because plans review chiropractic claims against the same coverage standards Original Medicare uses. Keep the treatment plan, goals, and progress measures current so the record supports each visit regardless of which plan pays.
Across the billing companies we vet, the strongest chiropractic billers treat January as its own project, with eligibility checks scheduled before the first visit of the year rather than after the first denial.
Expecting a wave of Medicare Advantage changes in January? We’ll match your practice with a vetted chiropractic billing company that verifies eligibility and works denials, typically within 30 minutes, with rates starting as low as 2.95%.
Common Mistakes During Medicare Advantage Plan Changes
These are the errors most likely to cost chiropractic practices money in early 2027.
- Assuming the plan carried over. A patient who never opened their plan’s non-renewal letter may not know their coverage ended December 31.
- Using an ABN for Medicare Advantage patients. The ABN applies to Original Medicare only, so it does not protect the practice when a Medicare Advantage plan denies a service.
- Billing routine visits without checking the supplemental benefit. A routine chiropractic allowance that existed in 2026 may be gone or smaller in 2027.
- Treating HMO patients without a referral or authorization. Growth in HMO plans means more patients whose coverage depends on getting approval first.
- Forgetting patients who return to Original Medicare. Patients who leave Medicare Advantage need claims sent to the Medicare Administrative Contractor, with the AT modifier on covered manipulation and ABN rules back in effect.
- Waiting for denials to reveal the problem. By the time a reason code 27 denial arrives, several more visits may already be on the books for the same patient.
- Overlooking dual eligible patients. Billing a Qualified Medicare Beneficiary for Medicare cost sharing is prohibited, even when the patient’s new plan leaves a balance.
- Skipping secondary coverage checks. A plan change can also change how a supplemental or Medicaid secondary policy coordinates with the primary.
Each of these is preventable with a January verification plan that starts now, while patients are still choosing their 2027 coverage. The patients most likely to be affected are often the ones you see most often.
In-House Billing vs. a Chiropractic Billing Partner
In our experience matching chiropractic practices with billing partners, January is when the gap between an overstretched front desk and a dedicated billing team shows up fastest, because eligibility work, denials, and patient balance questions all spike at once.
Chiropractor Billers is a free matching platform powered by Billing Service Quotes, which has connected more than 2,000 providers with billing companies across all 50 states. A person reviews every request before an introduction is made, and Tim Daniels, Director of Strategic Accounts, speaks with every provider who comes through the platform. Most practices are connected with matched billing partners in as little as 30 minutes.
Many billing companies in the network work inside the software chiropractic practices already use, including ChiroTouch, Genesis Chiropractic Software, ChiroFusion, Jane App, and ACOM Health. Many also offer credentialing and contracting, which helps when a practice decides to join the network of a growing Medicare Advantage HMO.
An in-house team can handle the transition if it has time to re-verify every Medicare Advantage patient before January. If it does not, compare partners on our Find Experts page or read more about Chiropractor Billers.
When comparing partners, ask how they verify Medicare Advantage eligibility before January visits, how quickly they work reason code 27 and 197 denials, and whether they track supplemental benefits by plan. Billing Service Quotes is compensated by the billing companies in its network, so the matching service is free to practices, and no practice is obligated to move forward with any company introduced.
Frequently Asked Questions
Do Medicare Advantage plans have to cover chiropractic care in 2027?
Medicare Advantage plans must cover what Original Medicare covers, which for chiropractors is manual manipulation of the spine to correct a subluxation, billed with CPT 98940 to 98942. Routine chiropractic visits beyond that are optional supplemental benefits, and some plans are cutting them for 2027.
When do the 2027 Medicare Advantage plan changes take effect?
Plan changes take effect January 1, 2027. The annual enrollment period runs from October 15 through December 7, 2026, so patients may switch plans until early December, and practices should re-verify coverage before each patient’s first visit in January to avoid denials.
Can chiropractors use an ABN for Medicare Advantage patients?
No. The Advance Beneficiary Notice applies to Original Medicare. Medicare Advantage plans use their own pre-service organization determination process for services that may not be covered, so practices should follow each plan’s process before billing a patient for a denied service.
What denial codes signal a Medicare Advantage plan change?
Claim adjustment reason code 27 means expenses were incurred after coverage terminated, and code 197 means a required authorization was absent. Out-of-network denials are also common when patients move from a PPO to an HMO that does not include the practice.
How many Medicare Advantage enrollees are changing plans for 2027?
CNN reported in October 2026 that nearly 3.2 million Medicare Advantage enrollees, almost 11%, must choose new coverage because their insurers stopped offering their plans. HealthWorksAI also found that 1,150 counties lost at least one Medicare Advantage carrier for 2027.
Does the AT modifier apply to Medicare Advantage chiropractic claims?
Many Medicare Advantage plans follow Medicare’s AT modifier rule for active, corrective spinal manipulation, but requirements vary by plan. Check each plan’s provider billing guide, and use the AT modifier on Original Medicare claims for covered manipulation, where it remains required.
Next Steps
- Review the rules for CPT 98940 to 98942 in our chiropractic CPT codes guide.
- Ready to compare billing partners? Visit our Find Experts page.
- Want to see how matching works? Start at the Chiropractor Billers homepage.
Get matched with a chiropractic billing partner before January’s Medicare Advantage changes hit, with rates starting as low as 2.95%.
