Chiropractic care is increasingly recognized as a valuable treatment option for those suffering from acute and chronic pain, as well as disorders affecting the nervous and musculoskeletal systems. The National Health Interview Survey (NHIS) data indicates a rise in the utilization of chiropractic services from 9.1% to 10.3% between 2012 and 2017. The American Chiropractic Association estimates that over 35 million Americans seek chiropractic care annually, reflecting its growing acceptance and popularity.
Beyond treatment, many individuals are also embracing chiropractic care for preventative health measures. The National Center for Complementary and Integrative Health (NIH) reported that the 2012 NHIS revealed 43% of U.S. adults who used osteopathic or chiropractic manipulation did so for disease prevention and overall wellness.
This growing trend naturally leads to important questions for those considering chiropractic treatment, including:
- What exactly is chiropractic care?
- What kind of training do chiropractors undergo?
- Will my medical insurance cover chiropractic care?
- If my insurance doesn’t cover it, what are my payment options?
WHAT IS CHIROPRACTIC CARE?
Chiropractic care is often recommended as an initial approach to managing pain. Organizations such as the American College of Physicians and a 2017 systematic review in the Journal of the American Medical Association advocate for non-pharmacological treatments, including spinal manipulation, for acute low back pain. This highlights the mainstream recognition of chiropractic benefits.
The core focus of chiropractic care is the central nervous system and the proper alignment of the back, spine, and neck. Chiropractors commonly address injuries, neck and back discomfort, joint pain, muscle spasms, and persistent body pain. Patients often experience pain reduction, improved mobility, and enhanced bodily function following chiropractic adjustments. These adjustments are also believed to support the body’s inherent healing capabilities.
Similar to other healthcare professionals, chiropractors typically begin with a comprehensive patient evaluation. This process involves a detailed interview, review of medical history, physical examinations, X-rays if necessary, and other diagnostic tests to arrive at an accurate diagnosis. Based on this assessment, a personalized treatment plan is then developed.
Chiropractic treatments primarily involve adjustments to the spine and neck. These adjustments can be performed manually, using the chiropractor’s hands, or with specialized instruments that utilize sound technology or other advanced methods. Many chiropractors also integrate advice on nutrition, healthy eating habits, and exercise into their patient care plans, promoting a holistic approach to wellness.
WHAT TYPE OF TRAINING DO CHIROPRACTORS RECEIVE?
Chiropractors are recognized as physician-level healthcare providers. To practice in the United States, they must earn a Doctor of Chiropractic (D.C.) degree from an accredited institution. Furthermore, chiropractors are required to pass the rigorous National Board of Chiropractic Examiners exam and obtain a license to practice from their respective state.
Licensure requirements vary by state, often including a specific state licensure examination. To maintain their professional licenses, chiropractors must participate in annual continuing education courses, ensuring they stay updated with the latest advancements and best practices in chiropractic care.
The Council on Chiropractic Education is the accrediting body for D.C. programs, ensuring high educational standards. Prospective D.C. students must complete at least three years of pre-medical undergraduate coursework before enrolling in a D.C. program. The curriculum mandates a minimum of 4,200 hours of combined laboratory, classroom, and clinical experience prior to graduation with a D.C. degree. Some chiropractors choose to pursue specialized postgraduate education to focus their practice on specific areas such as pediatrics, sports injuries, or neurology, further enhancing their expertise.
DOES MEDICAL INSURANCE COVER CHIROPRACTIC CARE?
The good news is that most medical insurance plans generally include some form of coverage for chiropractic care, particularly when it’s part of an active treatment plan. Typically, insurance plans are more likely to cover chiropractic treatment for acute conditions rather than for long-term maintenance or preventative care. However, the specific extent of coverage can vary significantly depending on the type of health insurance plan you hold.
Different types of healthcare plans, including employer-sponsored group plans, Medicaid, Medicare, and private insurance policies, offer varying levels of chiropractic coverage. Understanding the distinction between in-network and out-of-network providers is also crucial for maximizing your benefits. In most instances, chiropractic services are subject to co-pays, and any deductibles specified in your insurance plan will also apply.
EMPLOYER GROUP HEALTH BENEFIT PLANS
Employers have a wide array of medical insurance benefit options they can offer to their employees. Consequently, it is essential to carefully review your specific plan documents to understand the details of chiropractic care coverage provided by your employer’s plan.
Generally, it’s safe to assume that most employer-sponsored group health insurance plans offer some level of coverage for chiropractic visits. However, certain limitations and exclusions are likely to exist. For example, plans might restrict the number of covered visits per month or within a specific timeframe. They may also set a maximum amount they will pay for chiropractic services within a defined period.
Many group health insurance plans stipulate that chiropractic care is only covered if deemed medically necessary by a primary care physician or another medical doctor. This often means you’ll need a referral to see a chiropractor. Furthermore, continued coverage may depend on demonstrating ongoing improvement in your condition. It is common for plans to limit or exclude coverage for long-term or maintenance chiropractic care, focusing instead on treatment for acute issues.
MEDICAID
Medicaid is a joint federal and state government program designed to provide healthcare coverage to individuals who meet specific income or disability criteria. While federally funded, Medicaid programs are administered at the state level, giving each state some flexibility in determining which benefits are covered. Chiropractic care is considered an optional benefit under Medicaid, and therefore, not all states offer coverage. To determine if chiropractic services are covered in your state, it’s best to contact your local state agency that manages the Medicaid program. They can provide specific details about covered services and any limitations.
MEDICARE
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger people with disabilities. According to the Medicare website, Medicare Part B provides coverage for medically necessary manual manipulation of the spine to correct vertebral subluxation when performed by a licensed chiropractor or qualified provider. However, Medicare coverage for chiropractic care is limited.
It’s important to note that Medicare Part B does not cover maintenance chiropractic care, nor does it cover other services or tests ordered or provided by a chiropractor, such as X-rays, massage therapy, and acupuncture (except for acupuncture specifically for chronic low back pain under certain conditions).
If you have additional health insurance coverage in conjunction with Medicare, it might help cover expenses that Medicare Part B doesn’t. Additionally, Medicare Supplemental Insurance (Medigap) policies often provide more comprehensive coverage for chiropractic care and services ordered by a chiropractor compared to Medicare Part B alone. Medigap plans can help bridge the gaps in Medicare coverage, potentially leading to lower out-of-pocket costs for chiropractic treatment.
PRIVATE HEALTH INSURANCE
Private health insurance plans are available through state-based marketplaces established under the Affordable Care Act (ACA), often referred to as Obamacare, or can be purchased directly from insurance companies outside of the marketplace. The ACA itself does not mandate that insurance plans must cover chiropractic care. However, the majority of state marketplace plans do include chiropractic coverage to some extent.
If you find that plans available through your state’s marketplace exchange do not offer adequate chiropractic coverage, exploring plans purchased directly from insurance providers is another avenue. Similar to employer-sponsored and marketplace plans, private insurance plans often have exclusions and limitations on chiropractic coverage. These may include restrictions on the number of visits, duration of treatment, or types of conditions covered, often mirroring the limitations found in group health plans.
IN-NETWORK VS. OUT-OF-NETWORK
To maximize your health insurance benefits, it’s generally most cost-effective to seek care from providers who are in-network with your insurance plan. In-network providers have contracted rates with your insurance company, which typically means lower out-of-pocket costs for you. Some insurance plans offer partial coverage for services from out-of-network providers, but often at a significantly reduced level, resulting in higher costs for the insured individual. Many plans, particularly Health Maintenance Organizations (HMOs), may not cover any expenses incurred from out-of-network providers, except in emergency situations. To determine if a chiropractor is considered in-network for your specific insurance plan, you can contact your insurance company directly or inquire with the chiropractor’s office. Provider directories on insurance company websites are also valuable resources for finding in-network chiropractors.
WHAT ARE MY OPTIONS IF MEDICAL INSURANCE DOES NOT COVER CHIROPRACTIC CARE?
The cost of chiropractic care can vary, typically ranging from $30 to $200 per session. The exact price depends on factors such as the type of treatment needed, the chiropractor’s expertise and location, and the length of the session. If your medical insurance plan does not cover chiropractic care, or if your coverage is limited, you will be responsible for paying for your visits out-of-pocket. However, several options can help make chiropractic care more affordable even without comprehensive insurance coverage.
FLEXIBLE SPENDING ACCOUNT (FSA) OR HEALTH SAVINGS ACCOUNT (HSA)
If you have access to a Flexible Spending Account (FSA) or a Health Savings Account (HSA), these can be valuable resources for managing healthcare expenses, including chiropractic treatment costs.
An FSA is typically offered in conjunction with employer-sponsored group health insurance plans. Employees can elect to contribute pre-tax funds to an FSA each year, up to limits set by the IRS. These funds can then be used to pay for a wide range of qualifying healthcare expenses throughout the plan year. Chiropractic care expenses, including adjustments and related treatments, generally qualify as eligible medical expenses under FSA guidelines.
An HSA is another type of savings account, often linked to high-deductible health insurance plans offered through employers. HSAs are designed to help individuals offset the higher out-of-pocket costs associated with high-deductible plans. Similar to FSAs, contributions to an HSA are made on a pre-tax basis, and the funds can be used for qualifying healthcare and medical expenses, including chiropractic care. In many cases, employers also contribute to their employees’ HSAs, further increasing the available funds.
The IRS establishes annual contribution limits for HSAs. A significant advantage of HSAs over FSAs is that the funds in an HSA roll over year after year if not spent. Furthermore, if an employee changes jobs or leaves their current employer, the HSA account and its funds remain with the employee. In contrast, with many FSAs, funds must be used within the plan year or they are forfeited, although some FSAs offer limited rollover options.
SPEAK WITH YOUR CHIROPRACTOR
If you lack health insurance coverage for chiropractic care, or if you are concerned about the out-of-pocket costs, it’s worthwhile to discuss your financial situation with your chiropractor. Many chiropractors are understanding of patients’ financial constraints and may offer options such as private-pay discounts, sliding scale fees based on income, or payment plans to make care more accessible. Some chiropractic offices also offer third-party financing options that can help spread out the cost of treatment over time, making it more manageable.
CONSIDER SUPPLEMENTAL INSURANCE
Exploring supplemental insurance plans could be beneficial for covering chiropractic care costs. Supplemental insurance is designed to fill in the gaps in coverage left by standard health insurance plans. These plans can help cover expenses that your primary insurance might not fully cover, or doesn’t cover at all, such as copays, deductibles, and specific services like chiropractor office visits, lab tests, and X-rays. Policies vary, so it’s important to compare different supplemental insurance options to find one that meets your specific needs for chiropractic care coverage.
CHIROPRACTIC CARE IS HERE TO STAY
While chiropractic care is still sometimes categorized as complementary or alternative medicine, its effectiveness in treating various health conditions is increasingly recognized and supported by research. It can be a valuable and often preferred alternative to relying solely on pain medications for managing musculoskeletal issues. A 2016 Gallup poll revealed that among the one in four adults who consulted a chiropractor in 2016, a significant 67% reported their chiropractic care as being “somewhat good” to “very effective.”
Fortunately, as discussed, most health insurance plans do provide some level of coverage for chiropractic care, making it financially accessible to a wider population. If you have specific questions or concerns about your chiropractic care coverage, resources are available to help you navigate the complexities of insurance. Whether you are seeking a new medical plan or exploring supplemental coverage options, understanding your insurance benefits is key to accessing the chiropractic care you need.
