Does Health Insurance Cover Chiropractic Care?

More and more people are turning to chiropractic care to treat acute and chronic pain and disorders of the nervous and musculoskeletal system. According to the  National Health Interview Survey  (NHIS), the use of chiropractors increased from 9.1% to 10.3% from 2012 to 2017. Per the  American Chiropractic Association , it is estimated that more than 35 million Americans see chiropractors each year.

Many also turn to chiropractic care as a preventative treatment. As reported by the National Center for Complementary and Integrative Health (NIH), the 2012 NHIS showed that of the U.S. adults who used osteopathic or chiropractic manipulation, 43% used it for disease prevention and general wellness.

With the rise in popularity of chiropractic care as a viable treatment, it raises several questions for potential patients, including:

• What is chiropractic care?
• What type of training do chiropractors receive?
• Does health insurance cover chiropractic care?
• What are my options if health insurance does not cover chiropractic care?
  

WHAT IS CHIROPRACTIC CARE?

Chiropractic care is commonly used as a first line of defense against pain. For example, the American College of Physicians and a 2017 systems review in the Journal of the American Medical Association both support non-drug treatments, including spinal manipulation, for acute low back pain. 

Chiropractic care focuses on the central nervous system and alignment of the back, spine, and neck. Chiropractors often treat injuries, neck and back pain, joint pain, muscle spasms, and chronic body pain. After alignment, individuals frequently feel less pain with improved mobility and function. Alignments also help to support the body’s natural healing process.

Similar to other types of healthcare practitioners, chiropractors typically approach patient care with an initial evaluation. This includes a patient interview, medical history, examinations, x-rays, and other necessary tests to determine a diagnosis. From there, a treatment plan is developed.

Chiropractic treatments involve spine and neck adjustments that can be done manually with the hands or with the use of sound technology or other innovative devices. Many chiropractors incorporate guidance on nutrition, healthy eating habits, and exercise into treatment plans when working with patients.

WHAT TYPE OF TRAINING DO CHIROPRACTORS RECEIVE?

Chiropractors are considered physician-level practitioners. They must earn a Doctor of Chiropractic (D.C.) degree to practice in the United States. Chiropractors must also pass the National Board of Chiropractic Examiners exam and secure a state license.

Each state has specific requirements for licensure, which often includes a state licensure exam. To maintain their license, chiropractors must take annual continuing education courses.

The Council on Chiropractic Education accredits D.C. programs. Before enrolling in a D.C. program, students must complete three years of pre-medical undergraduate coursework. At least 4,200 hours of lab, class, and clinical experience are required before a student can graduate with a D.C. degree. Some go on to complete specialized postgraduate education to focus their practice on a specific area or population, such as pediatrics.

DOES HEALTH INSURANCE COVER CHIROPRACTIC CARE?

Most insurance plans cover some level of chiropractic care when it is a component of an active treatment protocol. Typically, health insurance plans cover chiropractic for short-term conditions vs. long-term care or maintenance. The level of coverage depends, in part, on the type of health insurance plan you have.

Employer group health benefit plans, Medicaid, Medicare, and private insurance plans are healthcare plans discussed below. The importance of understating in-network vs. out-of-network providers is also discussed. In the majority of cases, chiropractic care services are subject to a co-pay, and any deductible outlined in the plan applies, as well.

EMPLOYER GROUP HEALTH BENEFIT PLANS

There are numerous medical insurance benefit options for employers to offer employees. As a result, you’ll need to read the plan documents to determine the level of chiropractic care you are permitted to receive under your employer plan.

It is safe to say that most employer group health insurance offers some level of coverage for chiropractor visits. However, exclusions will likely apply. Visits are typically limited to a certain number per month or a specified time period. Plans might also provide a cap to the amount they will cover for chiropractic visits within a specified period.

Many group health insurance plans will only cover chiropractic care if deemed medically necessary by your physician. In other words, you will need a referral to a chiropractor. You might also need to show that there is continued improvement in your condition for coverage to continue. It is common for plans to stop covering chiropractic visits for long-term or maintenance care.

MEDICAID

Medicaid is a federal health care program offered to individuals who meet specific disability or income requirements. Though it is a federal program, it is operated by each state, meaning that states have some control over what is covered or not covered. Chiropractic care is considered an optional benefit, and not all states cover it. It is best to contact your local state agency that oversees the Medicaid program to find out if chiropractic care is covered.

MEDICARE

Medicare is a federal health care program operated by the federal government. Per the Medicare website, Medicare Part B covers medically necessary manual manipulation of the spine to correct subluxation if provided by a chiropractor or qualified provider. It does not cover maintenance care or tests and additional services offered or ordered by a chiropractor including x-rays, massage therapy, and acupuncture (except for low back pain).”

If you have additional health insurance coverage, you might be able to use it to cover expenses not covered by Medicare Part B. Also, Medicare Supplemental Insurance (also referred to as Medigap) often covers chiropractic care and services ordered by a chiropractor at a much higher level than Medicare Part B.

PRIVATE HEALTH INSURANCE

Private insurance plans are available through each state’s marketplace exchange (also referred to as Obamacare) or can be purchased directly from insurance companies. The Affordable Care Act (ACA) does not require insurance plans to cover chiropractic care. However, most state marketplace plans do cover it.

If there aren’t any available plans covering chiropractic care through one’s state marketplace exchange, another option is to research insurance plans purchased directly from insurance providers. Chiropractic care exclusions typically exist within private insurance plans and are similar to those outlined for employer group health coverage plans.

IN-NETWORK VS. OUT-OF-NETWORK

The greatest coverage from a health insurance plan occurs when you see in-network providers of that plan. Some plans will cover services for out-of-network providers but at a much lower level. Many plans will not cover any expenses incurred by out-of-network providers. To determine if a provider is considered in-network for a particular plan, contact the insurance company or your chiropractic care provider. 

WHAT ARE MY OPTIONS IF HEALTH INSURANCE DOES NOT COVER CHIROPRACTIC CARE?

Chiropractors charge an average of anywhere from $30 to $200 per session. Charges will vary based on the type of treatment, the chiropractor, and the chiropractor’s location. If your health insurance does not cover chiropractic care, you will need to pay for your chiropractor visit out-of-pocket. Some options to consider to reduce out-of-pocket expenses are outlined below.

FLEXIBLE SPENDING ACCOUNT (FSA) OR HEALTH SAVINGS ACCOUNT (HSA)

If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), you might be able to use it to help pay for chiropractic treatment.

An FSA is a spending account offered in conjunction with employer group health coverage. Employees can contribute pre-tax dollars to an FSA each year, subject to IRS limits. The money contributed can be applied to qualifying healthcare expenses. Most chiropractic care expenses fall under the qualifying medical expense category for an FSA.

An HSA is a savings account offered in conjunction with employer group health coverage. Often, HSAs accompany high deductible health insurance plans. An HSA helps offset the up-front out-of-pocket costs that result from having a high deductible.

Similar to an FSA, contributions made to an HSA are pre-tax dollars that can then be applied to qualifying healthcare and medical expenses. Chiropractic care expenses typically fall under the HSA qualifying healthcare expense category. In many instances, employers choose to contribute to the employee’s HSA plan, as well.

The IRS sets annual contribution limits for HSAs. Unlike FSAs, the money contributed to an HSA remains with the employee. If the funds are not used in the current plan year, they roll over to the next year. Further, if an employee terminates employment with his or her current employer, the money in the HSA remains with the employee. With an FSA, if the money is not used before terminating employment, the employee forfeits the money. 

SPEAK WITH YOUR CHIROPRACTOR

It might be worth explaining your situation with your chiropractor of choice if you do not have access to health insurance that covers chiropractor visits. Some chiropractors offer private-pay and sliding scale rates or discounts on services. They might also offer third-party financing to help with your up-front chiropractic costs.

CONSIDER SUPPLEMENTAL INSURANCE

Consider looking into supplemental insurance to cover the cost of your chiropractor visits. Supplemental plans can cover items that standard insurance plans don’t, including chiropractor office visits, lab tests, and x-rays.

CHIROPRACTIC CARE IS HERE TO STAY

Chiropractic care is still referred to as a complementary or alternative medicine treatment by many. However, its benefits have been proven in treating certain health conditions and can be a good alternative compared to pain medications. In a 2016 Gallup poll, of the one in four adults who saw a chiropractor in 2016, 67% indicated that their chiropractic care was between somewhat good to very effective.

Fortunately, most health care plans cover some level of chiropractic care. If you have questions or are concerned about chiropractic care coverage, the team at KBI Benefits can help. Whether you are looking for a new medical plan or are seeking a supplemental plan, we will work with our extensive network of insurance providers to determine the best plan for your needs.

Contact us today by submitting our online contact form or calling us at 408.366.8880. We look forward to working with you!