When you stop to consider that more than 22 million U.S. residents seek help from a licensed chiropractic physician every year, there’s an obvious question that usually follows: “Do insurance plans cover visits to a chiropractor?”
Traditional medical insurance plans: There are literally hundreds of different private medical insurance plans in existence. To know precisely what your plan covers, you’ll need to read the contract carefully, call a representative and ask questions, or phone your chiropractor and see if their practice is associated with the insurance coverage you have in place.
When it comes to chiropractic treatment, it is common for private insurers to only cover “medically necessary” procedures, which is usually interpreted to mean spinal manipulation for acute medical problems. Likewise, don’t expect your insurer to cover additional services like acupuncture, massage therapy, vitamins, nutritional advice, x-rays, or other non-essential services. For spine-related treatment of acute, short-term medical problems, you’ll usually have at least some amount of coverage if you plan offers chiropractic coverage at all.
Keep in mind that some private health care plans don’t cover chiropractic care at all. If you are currently enrolled in such a plan and would like to see a chiropractor in the future, consider switching plans. This step will involve some research and consultation with the office of a chiropractor whom you wish to visit.
Chiropractic office teams are usually well-versed in how the insurance industry operates and can offer you some guidance about the kinds of plans you might want to consider. In the end, however, the decision is yours. Take the time to consider all your health needs before switching insurance providers, and remember to ask lots of questions along the way.
Medicare: Generally speaking, if you are on one of the many Medicare health plans, either because you are older than 65 or are disabled, you’ll have to take some time to see exactly what types of chiropractic care will be reimbursed and for how much. At first, the situations seems complex if you try to understand all the different kinds of Medicare and learn about what they cover.
But for an individual, there will only be one kind of Medicare coverage to understand, namely whatever plan you are signed up for. Here is a short overview of how each part of Medicare operates with regard to chiropractic reimbursement:
- Part A: Part A is the so-called “hospital” coverage and is unrelated to chiropractic care. Part A is also considered the “basic” form of Medicare insurance coverage, along with Part B. You can opt out of Part B if you don’t want to pay the premium, but it’s usually a very good deal and millions of people over 65 pay their monthly Part B premium to get the many benefits that come with Part B. See the section below for details about how Part B coverage handles chiropractic services.
- Part B: If you have Part B coverage, your chiropractic treatment is only covered if it is considered “… Medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.” That means no “maintenance” treatments are covered after it’s been determined that your condition is no longer acute (short-term). Your chiropractor will inform you when your treatment has reached this phase so that you can make an informed decision about continuing with so-called “maintenance” services. If Part B is no longer in effect, you’ll pay for all care out of your own pocket.
Also note that Pat B does not cover orthopedic services, the initial exam, massage, x-rays, evaluations, vitamins, supplements, or physical therapy. In short, Part B is written and intended to treat spine-related, acute conditions for a short period of time. How much does Part B pay? You pay 20 percent of the treatment cost after covering your annual deductible, which is $198 for 2020.
- Part C, or Medicare Advantage: People who have opted to buy a Medicare Advantage plan, sometimes called Part C, face some different questions about coverage. That’s because each Part C plan is run by a different provider. Some have much more lenient payment policies than others.
For example, depending on your particular Part C Medicare Advantage plan, chiropractic care might be covered at 100 percent, if the treatment is deemed to be “medically necessary.” Read the fine print of your plan to see exactly what type of chiropractic treatment is covered and how much the reimbursement rate is.
- Part D: Medicare Part D pertains to prescription drug coverage so doesn’t have anything to do with chiropractic treatment. If you are signed up for Part D and Part B Medicare plans, it is the Part B section that will offer some coverage possibilities for chiropractic care.
- Medicare Supplement or Medigap: There are many different Medicare Supplement and Medigap plans out there, and the specific provisions of the one you have will dictate what kinds of chiropractic treatments are covered and up to what dollar amounts. Read your plan’s fine print, call your insurer, or call your chiropractor for help figuring out the specifics of coverage.
In general, most supplement and gap plans will pay at least 80 percent of covered, medically necessary chiropractic charges. Some pay more than 80 percent, all the way up to 100 percent. Expect to pay a “doctor’s visit” copay fee each time you go in for treatment.
Medicaid: Individual states run their own Medicaid programs and most don’t cover chiropractic services. However, you won’t know for sure until you check with your own state’s Medicare office. Call and ask whether they cover any chiropractic services at all and, if so, how much they reimburse for those services.
How To Find Out More
Even if you have your insurance contract in front of you, it can be challenging to figure out how much and what types of chiropractic care are covered. Let’s face it, most of us are not insurance experts, so it makes perfect sense to call your insurance provider and ask questions about the extent of their chiropractic coverage. Be sure to write down your questions before calling and know the name of your chiropractor, if you have one, before contacting your insurance company.
Your insurer will be able to look up a chiropractic practice by name and see whether that particular practice is on your plan. If it is, your insurer will the be able to explain to your what is and is not covered, what you can expect to pay for specific procedures, etc.
Finally, feel free to call any member of our team at Delaware Integrative Medicine. We’re always happy to help current or prospective patients figure out their insurance situation. We want everyone who walks into our offices to know in advance what their treatment costs will be.
No one likes to guess about medical expenses. When you’re hurting and need a doctor’s care. the last thing you want to worry about is your insurance coverage. So call us today, at (302) 258-8853, and find out what your insurance covers. We’ll explain the details to you so you can get the medical care you need without having to deal with uncertainties.