Does Medical Insurance Cover Chiropractic Care?

by Team eLocal
Young female receiving massage from therapist. A chiropractor stretching his patient's spine in medical office. Neurological physical examination. Osteopathy, chiropractic, physiotherapy

If you're struggling with low back pain or joint problems, you'll want to find relief as quickly as possible. Many people find chiropractic care an effective way to reduce discomfort and improve mobility, but it doesn't come cheap — especially if you require long-term maintenance services.

Does insurance cover chiropractors? This guide explains how health insurance coverage for chiropractic services works.

Does Insurance Cover Chiropractic Services?

Some health insurance policies cover chiropractic services as an alternative therapy. Typically, insurers only cover chiropractic care when recommended by a doctor.

You can determine whether your insurance covers chiropractic services by checking the list of covered benefits on your insurance documents. Alternatively, you can ring your insurer's helpline to ask about coverage for chiropractic care. If your policy doesn't cover your treatment, you'll have to pay for your sessions out of pocket.

Do Insurers Restrict Coverage for Chiropractic Care?

Most health insurance companies require a referral from your doctor before agreeing to cover chiropractic care, and they may ask to see a care plan. Many insurers also place annual limits on how many treatment sessions you can receive.

Depending on your policy, your insurer may restrict coverage to in-network practitioners only. An in-network practitioner has a formal contract with your insurance company to provide treatment and services for an agreed amount. Some insurers allow enrollees to choose an out-of-network chiropractor, but the practitioner doesn't have to honor the approved amount for in-network providers. Therefore, you may have to pay the price difference out of pocket.

Your insurance may also limit the type of chiropractic treatments it covers. For example, many policies cover straightforward manual adjustments by a chiropractor. However, they're less likely to cover additional services, such as diathermy, hydrotherapy and thermography.

How Much Does Chiropractic Care Cost Without Insurance?

Fees for chiropractic care depend on several factors, including the complexity of the problem, where you live and whether you require additional services, such as therapeutic massage. Chiropractors usually charge more in urban areas with higher costs of living than in more affordable or rural locations.

An initial consultation with a chiropractor is typically more expensive than the hourly rate for treatment, typically costing between about $60 and $160. After that, you should expect to pay between about $35 and $105 per session. Chiropractors operating cash-only or single-practice businesses often charge somewhat less than those who accept insurance or run multiple practices.

Your chiropractor may order X-rays before or during your treatment. Fees for X-rays range between about $45 and $156, depending on the rates in your area and how many images your chiropractor requires.

Does Medicare Cover Chiropractic Care — and Are There Limits?

Medicare only covers chiropractic care to treat spinal subluxation, a condition that affects the movement of the spinal joints. It may also cover acupuncture to treat low back pain when performed by a qualified chiropractor. Although Medicare doesn't usually restrict the number of sessions you can receive, it doesn't fund long-term maintenance care.

Medicare doesn't pay for other chiropractic services or diagnostics requested by a chiropractor, such as X-rays. However, it usually covers X-rays ordered by a physician.

If Medicare agrees to cover your chiropractic treatment, you are liable to pay the Part B deductible. You'll then pay 20% of the Medicare-approved amount for your treatment, while Medicare covers the remaining 80%.

You can purchase a Medicare Advantage plan through an approved private provider as an alternative to Original Medicare. Medicare Advantage plans must cover chiropractic services covered by Original Medicare, but some insurers also offer enhanced benefits. Therefore, your plan may entitle you to coverage for chiropractic services excluded from Part B. You may have to visit an in-network provider to be eligible, and most Medicare Advantage insurers charge co-pays of between $20 and $30.

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