Do Chiropractors Take Health Insurance

If lower back or neck pain is affecting you, you might be curious about the insurance coverage for chiropractic services.

Typically, chiropractic insurance coverage is categorized as an ancillary benefit.

This implies that a health plan might include this benefit as an optional “rider” appended to a primary medical plan, or there could be specific limitations on this coverage.

The extent of coverage and associated costs can differ based on the plan, insurance company, and geographical location.

Health Insurance Coverage For Chiropractors
Most chiropractors accept health insurance, and many plans cover chiropractic care for short-term conditions. However, coverage details such as deductibles, copayments, and benefit limits may vary: Photo courtesy (Healthline)

For accurate information, it’s advisable to consult the details of the particular plan you are considering.

Continue reading to gain insights into how insurance covers 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.

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.

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