In Puerto Rico, very few people carry Medicare Original by itself: most patients 65 and older are on an Advantage plan from Triple-S, MCS or MMM. That is where the confusion starts, because on paper the four look alike, and at the chiropractor they do not cover the same things. Here is the difference, plan by plan.
What does my Triple-S, MCS or MMM Advantage plan cover at the chiropractor?
Every Medicare Advantage plan must cover, at minimum, what Medicare Part B covers. For chiropractic, that means the manual spinal adjustment that corrects a demonstrated subluxation, per the official Medicare guidance on chiropractic services.
The difference is what each plan adds on top of that floor. We see it in this office every week:
| Plan | Initial evaluation | Chiropractic adjustment |
|---|---|---|
| Medicare | No | Yes |
| MMM Advantage | No | Yes |
| Triple-S Advantage | Yes | Yes |
| MCS Advantage | Yes | Yes |
That left-hand column decides what you pay on day one. With Triple-S Advantage or MCS Advantage, the visit where the doctor evaluates you falls under your coverage. With Medicare or MMM Advantage, the benefit covers the adjustment.
Why is the initial evaluation billed separately from the adjustments?
Because they are two different services. The initial evaluation is the visit where Dr. Julie Martínez Borgos, a chiropractor licensed in Puerto Rico since 2007, reviews your history, examines your spine and determines whether there is a subluxation and where it is.
Without that documented evaluation there is no adjustment to bill, because Medicare and Advantage plans only pay for the adjustment when the record demonstrates the subluxation being corrected. It is a documentation requirement, not an office formality.
What does no Advantage plan cover as a chiropractic service?
This is where most patients are caught off guard. None of the four plans cover the following under the chiropractic benefit:
- X-rays, even when taken during the same visit
- Laser therapy
- Therapeutic massage
- Lumbar traction
That does not mean you cannot receive them: it means they are not billed to the plan as a chiropractic service. At Cupey Plaza, digital radiology is done in the same office, with no outside referrals, so we quote the cost before anything is taken and you decide.
How do I know what I will pay before I arrive?
By calling. That is the only honest answer, because contracts differ within the same brand: two people with Triple-S Advantage can have different copays depending on the product they bought and how much of the year’s deductible they have used.
When you call (787) 223-9160, the team verifies your specific plan on that same call and tells you three things: whether your contract covers the initial evaluation, what your copay would be, and whether your plan requires a referral from your primary care physician. If a referral applies, you hear it before we schedule, not after. You can also read about when a referral is required with an Advantage plan and about what Medicare covers at the chiropractor.
This office accepts six plans: Medicare, Triple-S Advantage, MCS Advantage, MMM Advantage, SSS and MCS.
What if I switch plans during open enrollment?
Many people in Puerto Rico switch Advantage plans between October and December, and the change takes effect January 1. Three things worth knowing if you are in active care:
- Your deductible and visit count reset to zero under the new plan, even with the same doctor.
- A referral issued under the old plan does not carry over. If the new contract requires one, it has to be requested again.
- Coverage of the initial evaluation can change. If you move from a plan that includes it to one that does not, the first service of the year is billed differently.
Bring your new card to your first January appointment and the team re-verifies coverage on the spot. If you would rather handle it ahead of time, reach us from the contact page or call before your visit.
When should you seek immediate medical attention?
Coverage stops being the point if any of these appear. Seek immediate medical attention at an emergency room if you have:
- Loss of bladder or bowel control
- Worsening weakness in a leg or an arm
- Neck or back pain after a hard blow, a fall or a car accident
- Fever together with severe back pain
These signs call for urgent medical evaluation, not a routine appointment.
What to do now
Call (787) 223-9160, Monday through Thursday, 8:00 AM to 12:00 PM and 1:30 PM to 5:00 PM, and Fridays from 8:00 AM to 12:00 PM. The team verifies your plan on that same call and schedules your evaluation at Cupey Plaza, Suite 6. You can also reach us on WhatsApp or book online.
If your pain is in the neck, here is how we treat it, and here is what happens at your first visit.
This information is educational and does not replace a professional evaluation. Coverage depends on your individual contract; verify yours by calling the office or your health plan.