Some 20 million Americans visit chiropractors every year for help with various issues, according to the National Center for Complementary and Integrative Health (NCCIH).
Those 20 million people spend a lot of money on that care, too. How much? The NCCIH estimates it’s about $4 billion.
Fortunately, most health plans cover at least some of the cost of seeing a chiropractor. This includes policies bought from the marketplace set up by the Affordable Care Act (ACA) as well as Medicare and Medicaid coverage. If not, that $4 billion dollar chiropractic price tag could be a lot higher.
But don’t expect health insurance to cover all your chiropractor bills. While it’s not unusual for it to pay for the treatment of short-term conditions, it typically won’t pay for long-term or maintenance care.
You’ll learn about all the above in this article. You’ll also learn about:
- How specific types of health plans cover chiropractors
- Why health insurance doesn’t pay for maintenance chiropractic care
- What chiropractor visits cost (especially if you don’t have health coverage)
- Your options if your health insurance won’t pay for chiropractic care
- How to find out if your health plan covers chiropractic care
How do different health plans cover chiropractors?
Most types of health insurance pay for at least some trips to the chiropractor.
That’s surprising for a few reasons. One is that many still consider chiropractic care a form of complementary or alternative medicine. And many health insurance plans won’t cover “alternative” care.
Still, the fact remains that most health plans cover chiropractor visits. But to what extent do they cover it? That’s what you’ll learn here.
Job-based coverage and chiropractic care
Employers offer a wide range of health coverage to workers these days. That makes it hard to say how employer-sponsored plans will treat chiropractic care. Different plans offer different coverage.
Overall, job-based health insurance is more likely than not to cover a portion of your chiropractor visits. Don’t be surprised, though, if your plan places these or other restrictions on that coverage:
- Most health plans only pay for these treatments if a doctor says they’re medically necessary and prescribes them. In other words, you’ll need a referral.
- Many plans put a cap on how many times you can see a chiropractor in a month or year. Or they limit how much money they’ll pay for it in that same time frame.
- It isn’t unusual for health insurance policies to stop covering chiropractic sessions if your recovery hits a plateau. You need to show continued improvement. Otherwise, the chiropractic care becomes “maintenance” or “long-term” care, which many plans don’t cover.
Keep in mind that some employer-sponsored policies don’t cover chiropractic care at all. In that case, your only options are to switch to another plan — if that’s even possible — or pay care out of your own pocket.
Obamacare plans and chiropractor visits
Health coverage from the ACA or Obamacare marketplace usually covers chiropractic care.
This is true even though the ACA doesn’t require marketplace plans to provide such coverage.
Obamacare plans have to cover 10 categories of “essential health benefits.” One of those must-cover benefits is rehabilitative and habilitative services.
These services must “help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills.” Obamacare doesn’t specify the kinds of rehabilitative and habilitative treatments marketplace plans need to cover. Which means it doesn’t force them to pay for chiropractic care.
The good news is that many Obamacare plans pay for chiropractor visits and treatments anyway. Some do so because state laws mandate it. Others do so because a state’s “benchmark” plan — the one that serves as the model for all plans — include it.
As is the case with other types of health insurance, you’re much more likely to get coverage if your doctor refers you for chiropractic care. And, at the end of the day, it really depends on your specific health plan. Every plan has different requirements and limits when it comes to chiropractic care.
"Most Blue Cross PPO plans allow 20 to 30 visits per year, and are based on medical necessity for treatment," said Dr. Allen Conrad of Montgomery County Chiropractic Center. "Keystone HMO plans may cover treatment for 30 visits per year, but the referral is only good for 90 days. After the referral expires they must get another referral to continue treatment. Some plans like Cigna and United Healthcare may have a flat rate of 20 visits per year for example, which can be used at any time without any medical necessary restrictions." In other words, check with your insurer and your chiropractor before agreeing to any care.
If the policies in your state’s marketplace or “exchange” don’t offer chiropractic coverage, check out off-marketplace policies instead. You buy these directly from insurance companies, and they must follow the ACA’s rules just like marketplace plans do. One or more of them might cover chiropractor visits.
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Medicare and chiropractors
Medicare also covers chiropractor visits and treatments, but not as fully as some might hope.
For example, Medicare Part B pays for “manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.”
Note the part about the treatment needing to be “medically necessary.” That’s another way of saying your doctor has to prescribe it. And not only that, they need to prescribe it for a specific condition. (To correct a subluxation, or a slight misalignment of the spine.) If not, your Medicare Part B coverage may not pay for your chiropractor visit.
Expect to pay 20% of the Medicare-approved amount for chiropractic treatment. That’s assuming you’ve met your Part B deductible. If you haven’t, you’ll pay full price for care until you hit your deductible. After that, you’ll only pay 20% of the price for care.
Americans who have Medicare Supplement insurance, sometimes called MedSup or Medigap, may not have to pay anything for chiropractic care.
You’ll likely pay all costs for additional services or tests your chiropractor orders even if you have a MedSup or Medigap policy. Some examples include acupuncture, massage therapy, and X-rays. Medicare Parts A and B won’t cover those forms of care or their costs. Neither will a Medicare Supplement plan, like Medicare Part F or Medicare Part G.
Medicare Part A and Part B won’t pay for maintenance chiropractic care. In other words, if you see a chiropractor after your spine misalignment has been taken care of, you’ll pay for it out of your own pocket.
“When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy,” according to the official Medicare Benefit Policy Manual. It also states: “Chiropractic maintenance therapy is not considered to be medically reasonable or necessary, and is therefore not payable.”
Medicaid and chiropractic care
Medicaid also doesn’t cover chiropractors as much as you’d expect.
You would think Medicaid would pay for chiropractic care because Medicare does — to an extent. After all, these two government programs often mirror each other for what they do and don’t cover.
One big difference between them is the federal government operates Medicare. But states have some freedom in how they operate Medicaid. They’re required to offer certain “mandatory” benefits, but others are optional. A few examples of mandatory Medicaid benefits: physician care, inpatient and outpatient hospital care, and lab and X-ray tests.
“Chiropractic services” are an optional benefit under Medicaid. These services are grouped with things like:
- Prescription drugs.
- Physical and occupational therapy.
- Dental, hearing and vision care.
Because all of these types of care are optional, not all Medicaid programs cover them.
The best way to find out if your state’s plan covers chiropractor visits is to contact your local Medicaid agency. They can answer your questions.
Why doesn’t health insurance pay for maintenance chiropractic care?
Some health insurance plans don’t cover maintenance chiropractic care because many health insurance companies don’t see maintenance care as medically necessary.
Why don’t they consider it medically necessary? That’s a question only insurers can address.
It’s likely they prefer to pay for treatments that help people recover from an illness, injury or other situation. They don’t want to pay for treatments after someone hits a plateau and stops showing signs of improvement. That’s a common reason few health plans cover maintenance chiropractic care.
Don’t assume that’s true of your plan, though. Before you schedule anything, review your plan and see if it says anything about chiropractor visits. If it doesn’t, contact the insurance company and ask for clarity. And don’t just ask if your policy covers this type of care, but when and how much and for how long as well.
Do health insurance policies limit chiropractic coverage in any other ways?
The main ways health plans limit coverage for chiropractic care:
- They require a referral from a doctor.
- Some require your doctor or chiropractor to create and follow a care plan.
- Some make you use in-network or approved chiropractors.
- Most cap how many times you can visit a chiropractor in a given month or year.
It’s possible your health insurance plan places other limits on chiropractor coverage. If you’re not sure when or how or how much your plan covers chiropractic care, contact your insurer.
How much do chiropractor visits cost?
Chiropractor session costs range from $30 to $200, according to various sources.
Keep in mind there are a couple of different components to “chiropractic services.” For instance, there’s the initial consultation. Then there are the therapy sessions that come after that.
You may pay nothing for the initial consultation — even if you don’t have health insurance. As for the sessions that follow, you’ll probably pay around $100 for each chiropractor visit without insurance coverage. That’s just an estimate, though. Some chiropractors charge less per session, while others charge more.
Several different factors play a role in how much you pay for chiropractic care. Some of the most common are:
- How long the chiropractor has been practicing.
- The location of the clinic.
- Whether the clinic is a private practice or operates out of a hospital or medical center.
- If you need advanced or intensive treatment.
Much like it helps to shop around for health insurance, it helps to shop around for chiropractors, too. Don’t just go with the first one you come across while searching on line or the one that’s closest to where you live. Spend some time researching your options before you decide.
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What can I do if my health insurance won’t pay for chiropractic care?
The first thing you should do if your health plan won’t cover your chiropractor needs is talk with your doctor. See if they can help in any way. They may even be able to reach out to the insurance company on your behalf and smooth things out.
If that doesn’t work, though, contact the insurance company yourself. Tell them your story. Explain why you have to see a chiropractor.
And what if your insurer refuses to cover this kind of care? You might have to pay for it out of your own pocket. Before you hand over any money for a session, though, talk with the chiropractor. Some chiropractors offer discounts if you pay upfront, or if you pay in cash. Others give you free or additional treatments in those same situations.
Another option for people with health insurance that doesn’t fully cover chiropractic care is supplemental coverage.
Many companies sell supplemental plans that pay for some of the costs that standard health insurance policies won’t. This includes office visits, X-rays, lab tests, and even some supports, pillows and orthotics.
Also, supplemental plans don’t require you to get a referral from your doctor if you see an in-network chiropractor.
Just remember that these plans are supplemental. In other words, they’re supposed to supplement whatever other health coverage you have. They’re not supposed to replace it.
What if you’re on Medicare and you want more chiropractic care coverage? Consider switching to a Medicare Advantage plan. Some of these plans pick up the chiropractor costs Original Medicare won’t pay for. They may even cover costs tied to other alternative health services, too.
How can I find out if my health plan covers chiropractic treatments?
To find out if your health insurance covers chiropractor visits and treatments, pull out your policy and look it over. Don’t have it handy or can’t find it? Look on the insurance company’s website. Most have sample copies of all their policies that you can review.
And if reviewing your policy doesn’t help? Pick up the phone and call the insurer. Or send an email. Or start an online chat. No matter which option you choose, ask specific questions — like the ones listed below.
Questions to ask your health insurance company about chiropractic coverage:
- Does my plan (or this plan, if you’ve yet to buy or enroll in it) cover chiropractor visits?
- If so, do I need to get a referral from my doctor before I can see a chiropractor?
- Do I need to use specific, approved chiropractors, or can I go to anyone?
- How many chiropractor visits does it cover per month or year?
- Do I pay anything out of pocket, such as copays, for these chiropractor visits?
- Do chiropractic treatments count toward my plan’s deductible?
- Does my plan cover the cost of the initial examination?
- Does it pay for anything besides the chiropractic sessions themselves? Will it cover X-rays, tests or tools if my chiropractor prescribes or recommends them?
- How much will I have to pay for chiropractic treatments or services if my plan doesn’t cover them?
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