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If you suffer from lower back or neck pain, you may be wondering if chiropractic services are covered by insurance. Chiropractic insurance coverage is generally considered an ancillary benefit. This means that a health plan may cover this benefit as an optional “rider” added onto a major medical plan, or there may be certain restrictions to this benefit. Coverage and costs may vary by plan, insurance provider, and location, so it’s always best to check with the specific plan you’re interested in. To learn more about how chiropractic services are covered by insurance, read on.
Does insurance cover chiropractors?
The short answer is, it depends. Under the Affordable Care Act, Marketplace plans are required to cover 10 essential health benefits, including prescription drugs, maternity care, and preventive services. However, chiropractic care isn’t included as an “essential health benefit.” This means that ACA-compliant plans aren’t required by law to include chiropractic insurance coverage.
However, keep in mind that essential benefits are the minimum federal standard that ACA plans are required to cover. Each state has created its own requirements for health plans sold on the individual and family Marketplace. In some states, chiropractic insurance coverage may be a state-mandated benefit, meaning any plans sold in that state are required to cover chiropractic services. Health plans are also free to go beyond and include additional benefits beyond state requirements, which may include chiropractic insurance coverage.
In other words, even if you live in a state where chiropractic insurance coverage isn’t a mandated benefit, you may be able to find individual plans that cover chiropractic care. As mentioned earlier, if you’re wondering what types of chiropractic services are covered by insurance, it’s always best to check with the specific plan you’re interested in. eHealth’s plan finder tool makes it easy to find Marketplace plans that cover chiropractic services in your area.
Compare and find affordable health insurance.
How are chiropractors covered by insurance?
While exact benefits may vary by plan and by location, health plans that include chiropractic care may cover services such as:
- Initial exam by a licensed chiropractor
- Follow-up office visits
- Spinal and muscle manipulation
- X-rays and lab tests ordered by the chiropractor
- Related chiropractic equipment, such as lumbar support, orthotics, braces, etc.
Keep in mind that each plan may have different rules for coverage. Plans may include limits on chiropractic insurance coverage such as:
- “Medically necessary”: many Marketplace plans will only cover “medically necessary” chiropractic care. Your primary care doctor may need to show that the chiropractic services are medically necessary to treat an injury or medical condition. In addition, the insurance company may require proof that the condition is improving with the treatment.
- “Maintenance” services: many plans don’t cover “maintenance” chiropractic services, meaning that long-term chiropractic services that aren’t related to a specific injury may not be covered. Instead, the plan may require your doctor create an “active care plan” that shows the chiropractic services are treating a specific injury. Your plan may also refuse to cover the chiropractic services if it’s not clear that you’re improving.
- Provider networks: if the plan requires you to use a provider network, you’ll need to make sure the chiropractor you select is included in the network. If you go out of network, your costs could be higher or may be not covered at all. Some plans may require you to get a referral from your primary care doctor before the initial chiropractor visit.
- Cost sharing: as with any benefit, chiropractic costs may vary by plan, and you may have cost sharing (the portion you pay for treatment). You may owe a copayment (a flat fee, usually paid at the time you receive the service) or a coinsurance (a percentage of the cost). Your plan may require you to meet a deductible before plan benefits kick in, meaning you may cover all chiropractic costs until you’ve met the minimum amount.
- Annual or monthly maximum cap: most plans limit coverage to a set number of visits in a given month or year. After you’ve reached this limit, you may have to pay out of pocket.
Again, as mentioned before, specific details vary widely by plan, and not every plan may be offered in every location. If you’re wondering how chiropractic services are covered by your insurance plan, your best bet is to check your plan’s Evidence of Coverage documents, which include detailed information on benefits. If you’d like help finding a plan that fits your needs, an eHealth licensed insurance agent can walk you through your options as well.
How can I find chiropractic health coverage?
Hopefully you now have a better idea if chiropractic services are covered by insurance, and how most insurers include this benefit. As always, plan benefits and costs vary quite a bit, and doing a little research can save you money and help you find a plan that fits your specific needs. If you’d like to get started researching plans that cover chiropractic services, eHealth has a wide range of individual and family plans to fit different needs and budgets. Remember, plan costs are regulated by law, meaning that you’ll pay the same price for insurance coverage no matter where you buy from. This also means it makes sense to take the time to shop around to find a plan that best fits your needs. Our free plan finder tool makes it simple to compare plans side by side in one place. And if you need help along the way, eHealth’s trusted licensed insurance agents are just phone call away.
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