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According to a 2015 Gallup poll, 65% of Americans have sought care for back or neck pain in their lifetime. Unfortunately, chiropractic treatment can be very expensive without insurance, which raises the question, “Does insurance cover chiropractors?”
This page provides an overview of what you need to know regarding chiropractic care and health insurance policies to help you understand what you are covered for.
If your current health insurance plan is difficult to understand, you may want to consider other providers that prioritize your understanding of available services and accessibility to the best coverage possible.
Find in this article:
What Do Chiropractors Do?Which Health Insurance Plans Cover Chiropractic Care?How Often Can You Visit A Chiropractor?What If My Insurance Provider Doesn’t Cover Chiropractic Care?
What Do Chiropractors Do?
Chiropractors assist in preventing, diagnosing, and treating a patient’s neuromusculoskeletal system. In plain language, chiropractors most commonly assist patients with back and neck pain. They accomplish this feat by providing spinal adjustments and helping to promote good alignment, which aims to reduce pain or eliminate it altogether.
Specifically, chiropractors work on the following parts of the body found in the back and neck:
A common question surrounding chiropractors is whether or not they’re “real doctors”. Although chiropractors do not hold a M.D. and therefore do not have the title of “Dr.”, they should have extensive experience in the field, education credentials in related programs of study, and a valid license to practice. If in doubt, ask your chiropractor about their qualifications and experience before you book an appointment.
Do Medical Insurance Plans Need to Cover Chiropractic Treatment?
Under the Affordable Care Act (ACA), all medical insurance plans must provide coverage for physical therapy. However, health insurance companies are not required to offer coverage for chiropractic treatment.
That being said, thanks to the growing popularity of chiropractic treatment, many still do. The specifics will vary greatly based on your particular health insurance plan, especially because chiropractic treatment is sometimes considered to be “alternative treatment” by health insurance companies.
Which Health Insurance Plans Cover Chiropractic Care?
Examples of health insurance plans (both public and private) that may cover chiropractic care in some way include:
- Private plans from popular health insurance companies
- Workers’ compensation plans for individuals who get hurt at work
- Medicare plans for individuals age 65 and older
- Medicaid plans for low-income individuals
- Veterans Affairs (VA) plans for retired members of the military
As you can see, the vast majority of healthcare plans do provide some sort of chiropractic coverage.
But the way in which these plans provide coverage varies greatly. Very few plans will offer an unlimited number of visits to the chiropractor for any reason at all. Instead, you will likely face at least some restrictions depending on how expansive your plan is.
Common Medical Insurance Restrictions For Chiropractic Treatment
Now that we know that chiropractic treatment coverage is often determined by your plan in particular, let’s look at the various ways in which you might be restricted depending on what type of plan you have.
Did You Meet Your Deductible?
A deductible is a certain dollar amount threshold that you must pay for by yourself before your insurance company begins providing coverage for medical expenses. Although a deductible isn’t unique to chiropractic services, it’s important to keep in mind that you usually need to hit your deductible before you receive coverage for them.
Different types of plans will have different deductibles. In general, the more you pay for your monthly premium, the less you pay for your annual deductible. Individuals who make frequent use of healthcare services will generally be better served by a plan with a lower deductible. Employer-sponsored healthcare plans generally have the best balance of premiums to deductibles because the employer pays a portion of the employee’s monthly premium.
If you have a high-deductible health plan but wish to be covered for chiropractic visits before you hit your deductible, consider enrolling in a gap health insurance plan. This type of plan can allow you to receive coverage on chiropractic visits, even before you’ve hit your deductible.
Which Chiropractors Are Covered?
Different health insurance plans have different rules regarding which chiropractors you can or cannot see if you want to receive coverage.
For example, Health Maintenance Organizations (HMOs) generally require you to pick from a list of approved chiropractors, without exception, if you wish to receive coverage. Preferred Provider Organizations (PPOs), on the other hand, will sometimes provide partial coverage if you venture outside of the approved network of chiropractors. Others will not restrict you at all and offer full coverage for any chiropractor you wish to see, although these types of plans are generally more expensive than HMOs and PPOs are.
Read our article on five popular types of health insurance plans and the restrictions on which healthcare professionals you can see for each one.
Do You Need A Referral?
As covered in the section above, different types of health insurance plans will restrict you in regards to which chiropractors you can visit. On a similar note, certain types of health insurance plans will require you to get a referral to a chiropractor—who is generally considered a specialist—from your primary care physician before you are eligible to receive coverage for chiropractic services.
Along with covering in-network restrictions, our article on popular health insurance plans details referral requirements to get coverage from specialists under five different types of common healthcare plans.
How Often Can You Visit A Chiropractor?
Health insurance plans rarely allow you to see healthcare professionals as frequently as you desire. Most will provide some sort of annual limit on how many times you can receive care. Even very basic services, such as physical examinations, are often limited in this way.
Your annual limit on chiropractic visits will vary based on how extensive your coverage is and may vary based on specific services you receive from a chiropractor when you visit.
Do You Have An Annual Claim Limit?
Along the same line of thinking, certain health insurance plans will set a limit on the benefits you are eligible to receive for a certain service within a certain year (rather than capping your annual number of visits). Certain chiropractic services may contribute more towards your annual claim limit than others if they are more expansive in scope (and therefore more expensive for the health insurance company to cover).
Chiropractic Active Care Plans vs. Maintenance (Long-Term) Care
Active care refers to chiropractic treatment that is rendered in response to a specific incident, such as after an injury. An active care plan generally consists of frequent treatment right after the injury, with care becoming less frequent as the patient’s health stabilizes.
Maintenance care, also called long-term care, is the type of care that generally follows active care once the patient’s health has stabilized. For example, you may opt to continue visiting a chiropractor to prevent relapses back into an injured state or to simply keep a helpful line of communication open.
In general, many healthcare plans will cover chiropractic services on an active care basis, but not necessarily on a maintenance (long-term) basis. The terms and conditions will be spelled out clearly in your health insurance plan contract where you will usually see the word “medical necessity”. If your chiropractic visits are considered to be a medical necessity, then you’ll generally be able to receive coverage. If you have recovered from whatever caused your need for a chiropractor, the visits will generally not be deemed medically necessary and you may lose coverage.
Example of variable chiropractor health insurance coverage
A patient is involved in a car accident and starts to experience significant back and neck pain, which prevents them from working and therefore requires immediate treatment.
Right away, the patient is referred to a chiropractor and begins an intensive active care treatment regimen. During this time, the patient may visit the chiropractor every week or multiple times per month.
After a certain period of time, the patient begins recovering from the car accident. He is now able to function without pain and returns to work. Here, the active care portion of his treatment ends.
The patient wishes to continue seeing the chiropractor as a safeguard against long-term injury. Here, the maintenance care portion of his treatment begins. Although it’s helpful to continue visiting the chiropractor, it’s not a complete necessity.
Once the patient has recovered from the initial effects of the car accident in regards to their back and neck pain, the insurance company may cease providing coverage for chiropractic visits. Or, if the patient is covered for maintenance care in regard to chiropractic services, coverage may continue uninterrupted.
The specifics of what is considered active versus maintenance care are usually dictated by what is considered to be medically necessary.
What If My Insurance Provider Doesn’t Cover Chiropractic Care?
If your insurance plan doesn’t cover chiropractic care (or does not offer as much coverage as you’d like), you’ll usually need to pay for services in full without any help from your insurance company. Be sure to contact many different chiropractors in your area and explain your situation—many will hopefully be sympathetic to your situation, but some will charge higher rates than others, so it makes sense to shop around and get the best deal possible.
Who Should Consider Chiropractic Coverage in Their Health Insurance Policies?
Although chiropractors are known for helping patients with back pain and spine problems, they’re not the only type of healthcare professional that deals with those types of problems.
- Chiropractors are useful for individuals who are generally healthy but who have recurring pain for reasons such as old sports injuries that have technically healed but still cause discomfort.
- If you have more acute problems—such as fractures—or you are experiencing pain due to another ailment such as arthritis, you may benefit more from seeing a different type of specialist.
- When in doubt, book an appointment with your primary care physician. Explain your problem to receive the most accurate assessment of who would be of the most help for you in particular before you enroll in a new healthcare plan.
Although not technically required by law, visits to the chiropractor are often covered by many types of health insurance plans from a variety of different sources. However, the specifics of your coverage, including how frequently you can visit, which chiropractors you can see, and how long you’re covered for after an injury will vary greatly depending on the scope of your plan in particular. If you’re someone who has frequent back, spine, or neck pain without any clear source from a different ailment (such as arthritis), you may want to consider making sure you’re covered for chiropractic services, at least in some regard, the next time you renew your health insurance plan.
No matter which type of plan you choose or how extensive you want your chiropractic coverage to be, make sure to partner with a transparent and trustworthy company that puts the mental and physical wellbeing of the patient first. When you know exactly what you’re covered for and exactly how much everything will cost, you can get the chiropractic services you need, when you need them, without needless stress or having to sift through the fine print of your contract.