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Does Health Insurance Cover Visits to the Chiropractor?

Approximately twenty million Americans visit a chiropractor every year for a slew of ailments, including back pain, neck pain, muscle tension, injuries and more. Fortunately, available research has shown that chiropractic visits can provide a wide degree of relief and greatly assist individuals. However, like most medical payments, it is difficult for most to be able to afford to fully bear the cost of chiropractic visits without health help.

Does health insurance cover chiropractic visits? The answer depends, but the good news is that it is often yes, and while there is no specific chiropractor health insurance, there are plenty of options which are available in the other insurance plans you may purchase.

Whether or not your insurance covers visits to the chiropractor depends on what type of insurance plans you purchase. Since the passage of the Affordable Care Act, all insurance plans are supposed to offer ten essential health insurance benefits. Sadly, there is nothing specific about chiropractic in there, although one could make the argument that it should be covered as either “rehabilitative services” or “preventative and wellness services” – and, indeed, some states do.

This means that it is up to an individual insurance plan as to whether or not they want to cover chiropractic services, and that consumers who shop will have the opportunity to purchase such a plan if they are willing to do so.

Broadly speaking, there are three kind of insurance available to Americans: Job-based coverage, individual purchased or public insurance.

Job-based Coverage

Almost half of all Americans receive their health insurance through their job. Employers typically limit the amount of health insurance options which their employees can buy, meaning that you more or less take what you get.

This can limit the amount of options you have when it comes to purchasing health insurance. As such, you will have to consult with your insurance company in order to determine whether or not chiropractic care is covered.

The good news is that there is nothing which stops an employer from purchasing a plan which covers chiropractic services, but remember that different plans will offer different levels of coverage. It is possible that you will be responsible for percentage of coverage, or you will be offered a limited amount of visits before your insurance stops offering coverage.

Individually purchased

These are insurance plans which are purchased off of the health insurance market, or plans which are purchased outside of someone’s individual job.

During open enrollment, you have the opportunity to check out the various healthcare plans which are open and enroll in a plan which best matches your needs. The good news here is that this gives you more options and individual control over what your insurance covers. The bad news, of course, is the expense associated with this purchasing, as these plans can be very expensive.

What types of services are covered depends on your state. The ten essential health benefits create a floor of services which must be offered by any health insurance plan, but each state has the option of mandating that some services be covered. Some states do consider chiropractic to be covered as essential health benefits, but only if those services are meant to provide rehabilitative care.

You can purchase coverage which is more generous and will cover more health insurance options. However, be warned: That can get very expensive.

Public insurance

This includes programs like Medicare or Medicaid, and there is a difference between the two. Medicare is insurance designed to cover the seniors of this country, while Medicaid and ship are designed as federal safety net insurance for individuals who cannot afford insurance otherwise.

When it comes to Medicare, there is good news, although maybe not as good news as you may want to hear: According to Medicare.Gov, chiropractic services, including manipulation of the spine is covered, as long the manipulation is deemed medically necessary. This means that you can get chiropractic covered, but another doctor has to actually make a referral or prescription for these services. Furthermore, you will have to pay 20% of all services incurred. Your Part B deductible will apply, meaning that any payments you make will count towards meeting your overall deductible.

It’s important to also understand that Medicare plans are not uniform, and different medicare plans may offer different coverage. As such, make sure you contact your insurance broker before actually seeing a chiropractor.

Medicaid operates differently. The federal government sets and operates Medicare, but Medicaid is largely operated and funded by the states. This means that they have more freedom to offer – or not offer – different coverage, and some states are famously more generous in their coverage than others. Like with Obamacare coverage, there are some benefits that are mandatory (such as general physician care or lab work), but chiropractic services are considered to be optional. Again, you will need to contact your insurance company in order to determine if Medicaid covers chiropractic visits.

Health Savings Accounts

Health Savings Accounts are tax-advantaged accounts. You can put money into these account (pre-tax) and use them to cover a variety of medical expenses. This can result in major tax savings. However, not every medical claim is covered by HSAs. However, there is good news: Chiropractic care is covered under HSAs. While this is not the same as full insurance coverage, it is a major potential financial benefit and can save you achieve significant savings on your taxes.

If you want to visit a chiropractor health insurance may be able to help you cover the costs. The most important thing is that you do your research and speak with your insurance company before making a visit – after all, the last thing you want is to be surprised by a massive health insurance bill.

Contact us with any questions you may have!