If you experience lower back or neck pain, you might want to explore the coverage of chiropractic services by insurance.
Insurance companies generally categorize chiropractic coverage as an ancillary benefit. They may offer it as an optional “rider” attached to a primary medical plan, or there may be specific restrictions on the coverage.
The extent of coverage and associated costs depends on the particular plan, insurance company, and geographical location.
For precise information, it’s recommended to review the details of the particular plan you are contemplating.
Read on to discover insights into the insurance coverage of chiropractic services.
Does insurance cover chiropractors?
In short, Affordable Care Act (ACA) Marketplace plans do not have an obligation to include chiropractic care as an essential health benefit.
While federal standards mandate certain benefits, each state sets its own requirements.
Some states may mandate chiropractic coverage, but even if not mandated, individual health plans can choose to include it.
You can find plans that cover chiropractic care, and for specific details, it’s advisable to consult the selected plan.
Use tools like eHealth’s plan finder for assistance in locating Marketplace plans with chiropractic coverage in your area.
Also read: Are Eye Exams Covered By Health Insurance?
How are chiropractors covered by insurance?
Health plans incorporating chiropractic care may cover a range of services, including a licensed chiropractor’s initial examination, follow-up office visits, spinal and muscle manipulation, X-rays, lab tests ordered by the chiropractor, and related equipment such as lumbar support, orthotics, and braces.
However, plans may vary in their coverage rules:
- Medically necessary”: Many Marketplace plans cover only chiropractic care deemed medically necessary, requiring your primary care doctor to demonstrate its medical necessity for treating an injury or condition. You may also need to provide proof of improvement.
- Maintenance” services: Plans might not cover long-term, non-injury-related chiropractic services unless they are part of an active care plan addressing a specific injury. Improvement must be evident for continued coverage.
- Provider networks: If the plan mandates a provider network, choosing a chiropractor within the network is essential to avoid higher costs or non-coverage. Some plans may require a referral from your primary care doctor for the initial chiropractor visit.
- Cost sharing: Chiropractic costs may involve copayments or coinsurance, with variations between plans. Meeting a deductible is common, and it requires covering all costs until reaching the minimum amount before plan benefits apply.
- Annual or monthly maximum cap: Many plans limit coverage to a set number of visits per month or year. Once this limit is reached, additional visits may require out-of-pocket payments.
Details vary widely by plan, and not all plans are available in every location.
To understand how your insurance plan covers chiropractic services, refer to your plan’s Evidence of Coverage documents for detailed information.
If you need assistance in finding a suitable plan, licensed insurance agents from eHealth can guide you through your options.
Health insurance plans that may cover chiropractic care:
- Medicare Part B may help cover a percentage of one type of chiropractic treatment: spine manipulation to correct bones in the spine that are out of position.
- Auto insurance may also cover recommended or reasonably necessary chiropractic treatment for neck and back injuries from a covered accident.
- Some private health insurance plans, such as AARP, Aetna, Cigna, and others, may cover chiropractic care under “alternative treatment” or “extras cover” policies23. The amount you can claim on your visits will depend on your policy
If your health insurance plan does not cover chiropractic care, or if you have reached your benefit limit, you may have to pay out-of-pocket for your chiropractic sessions.
Some possible ways to pay for your chiropractic care include:
- Using a Health Savings Account (HSA) or Flexible Spending Account (FSA) if you have one.
- Applying for a medical credit card, such as CareCredit, that offers low-interest or no-interest financing for health care services.
- Using a regular credit card or savings, but be aware of the interest rates and fees that may apply.
- Shopping around for different chiropractors and comparing their prices and services. You may be able to find a chiropractor that offers discounts, payment plans, or sliding scale fees based on your income or situation
T Bag is an insurance expert with a degree in actuarial science from the University of Hartford. He has over 10 years of experience in risk management, product development, and pricing. He is a certified actuary and a member of the American Academy of Actuaries. He is passionate about helping clients find the best insurance solutions for their needs and goals. He is looking for new opportunities in the insurance field.