Will Insurance Cover Chiropractic Care? Essential Information You Need

How do health insurance plans work?

Health insurance is a contractual agreement between an individual and an insurance company, where the insurer covers a portion of medical expenses in exchange for monthly premiums. Most health insurance plans are structured to help individuals manage healthcare costs by covering various services, including preventive care, emergency services, and specialty treatments like chiropractic coverage. Medical professionals should understand how these plans operate, especially when coordinating patient care or verifying insurance coverage.

Premiums are fixed monthly payments that maintain insurance coverage. Many major medical plans also have deductibles, which require patients to pay a set amount out-of-pocket before the insurance company contributes to healthcare expenses. Once the deductible is met, coinsurance comes into play, splitting costs between the patient and the insurer—for example, the insurer might cover 80%, while the patient pays 20%. Copayments, another common feature, are fixed fees for services like chiropractic visits or appointments with a primary care physician.

In-network providers offer lower service rates, as insurance providers negotiate discounts with selected healthcare professionals. Being part of an insurance company’s network ensures more affordable chiropractic care for patients. Supplemental coverage may also be available to extend benefits beyond primary plans, providing options for services not typically included.

Most health insurance plans cover preventive care in full, including annual check-ups, which can be essential in supporting an active treatment plan. Coverage for chiropractic care varies depending on the policy, but many insurance cover chiropractors as part of their standard offerings. Understanding the specifics of each insurance provider’s plan helps healthcare practitioners guide patients toward the best use of their benefits while ensuring appropriate billing procedures.

Why is chiropractic treatment not considered an essential health benefit?

Chiropractic treatment is not considered an essential health benefit under many health plans because it is often categorized as alternative or complementary care rather than primary medical treatment (National Center for Complementary and Integrative Health, 2019). Essential health benefits, defined under the Affordable Care Act (ACA), include necessary services for basic health maintenance, such as emergency services, hospitalization, and prescription drugs. While beneficial for managing a specific injury or musculoskeletal condition, chiropractic care does not fall under this approved list of mandatory services that health plans must cover.

Insurance providers prioritize treatments with broad clinical guidelines and widespread medical consensus. Although chiropractic care can be part of an active care plan, particularly for patients experiencing back pain or joint issues, it is generally seen as a supportive rather than a primary treatment. Services like massage therapy, often used alongside chiropractic adjustments, are similarly excluded due to their classification as non-essential.

Coverage decisions also depend on the nature of the patient’s condition and the treatment's perceived necessity. For instance, a chiropractor's visit to manage a chronic condition might receive different consideration than a first visit following a specific injury. Ultimately, excluding chiropractic care from essential benefits reflects insurers' focus on treatments with universally recognized medical necessity and long-term cost-effectiveness.

Controversies surrounding chiropractic treatments

Various controversies have surrounded chiropractic treatments, raising concerns within the medical community and among healthcare professionals (Ernst, 2008). One key issue is the lack of scientific validity behind the concept of vertebral subluxation (Marcon et al., 2019), a foundational principle in traditional chiropractic care. While some evidence supports spinal manipulation for back pain, systematic reviews have not consistently proven its efficacy for other medical conditions (Ernst & Canter, 2006). During an initial consultation, patients may be offered services like X-rays, which some critics argue are overused without clear clinical justification.

Internal divisions within the chiropractic profession contribute to ongoing debates (Pollard, 2021). “Straights” adhere strictly to traditional philosophies, while “mixers” incorporate broader medical practices, leading to differing approaches when patients receive care. Safety is another concern, especially regarding spinal manipulation in the cervical spine, which has been linked to rare but serious complications, including stroke and nerve damage.

Ethical issues have also emerged, with some chiropractors making unsubstantiated claims about treating conditions beyond musculoskeletal issues. Additionally, critics highlight commercialism in chiropractic services, raising questions about patient care quality versus financial motivations. Historical opposition to vaccination by certain chiropractors further complicates its relationship with mainstream medicine (Gleberzon et al., 2013), emphasizing the need for evidence-based care and transparency in patient management.

Examples of health insurance plans that cover chiropractic care

Many health insurance plans include chiropractic coverage as part of their benefits, especially when treatments are part of an active treatment plan. Coverage varies depending on the insurance provider, plan type, and state regulations. Below are examples of major insurers offering chiropractic care benefits.

Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS) often includes chiropractic care in its health plans, particularly when it's part of an active treatment plan to improve musculoskeletal health (Blue Cross Blue Shield, 2019). Coverage details, such as visit limits and copay amounts, vary depending on the specific BCBS subsidiary and plan.

Medicare

Medicare Part B covers manual spinal manipulation by a chiropractor to correct vertebral subluxations. After meeting the Part B deductible, patients typically pay 20% of the Medicare-approved amount (Medicare, 2019). However, Medicare does not cover additional services ordered by the chiropractor, such as X-rays, massage therapy, or acupuncture.

Cigna

Cigna offers various health plans that may cover some or all chiropractic care costs (Cigna Healthcare, 2024). Coverage specifics, including visit limits and cost-sharing requirements, depend on the plan and whether the provider is in-network. Cigna often requires documentation of medical necessity.

UnitedHealthcare

UnitedHealthcare offers plans that may cover 30 chiropractic visits annually, especially for back and neck pain (UnitedHealthcare, 2024). Coverage specifics vary based on the plan type, and most require patients to use in-network chiropractors to maximize benefits.

What chiropractic services are covered by such plans

Health insurance plans often include chiropractic services to treat musculoskeletal health issues. Coverage typically focuses on treatments that improve mobility, manage pain, and support injury recovery. However, the specifics vary depending on the insurance provider and policy, so verifying individual plan details is essential to understand the covered services.

Spinal manipulation

Spinal manipulation is one of the most commonly covered chiropractic services. It is often used to manage lower back and neck pain. Insurance plans, including Medicare Part B, generally cover manual manipulation of the spine to correct vertebral subluxations.

Assessment and treatment plans

Many insurance plans cover comprehensive assessments and treatment plans developed by chiropractors. These evaluations involve diagnosing musculoskeletal conditions, determining treatment goals, and creating personalized care plans tailored to each patient’s needs.

Short-term care

Insurance policies frequently include coverage for short-term care, especially as part of an active treatment protocol. This type of care addresses acute conditions, such as sudden back pain or injury-related discomfort, aiming to alleviate symptoms over a defined period to promote recovery.

Personal injury protection (PIP)

In states offering personal injury protection (PIP), auto insurance policies may cover chiropractic treatments after car accidents. PIP coverage often includes medical costs and, in some cases, lost wages. This benefit ensures patients can access necessary chiropractic care to manage injury-related pain and restore functionality.

Services for musculoskeletal health

Most health insurance plans that include chiropractic benefits cover services to improve musculoskeletal health. These treatments help alleviate discomfort, enhance mobility, and promote overall well-being. Covered services may address conditions such as joint pain, muscle tension, and posture-related issues, supporting patients’ long-term physical health.

Key takeaways

Understanding what chiropractic services are covered by health insurance plans is essential for making informed healthcare decisions. Coverage often includes spinal manipulation, comprehensive assessment and treatment plans, short-term care for acute conditions, and benefits under personal injury protection (PIP) for accident-related injuries.

Additionally, many plans cover services to improve musculoskeletal health, helping patients manage pain and enhance overall well-being. Since coverage varies by provider and policy, verifying plan specifics is crucial to maximize benefits and ensure effective treatment options are available.

References

Blue Cross Blue Shield. (2018, September 26). Blue Cross and Blue Shield Federal Employee Program (FEP) keeps medical premiums stable while expanding plan offerings for 2019. Blue Cross Blue Shield Association. https://www.bcbs.com/about-us/association-news/blue-cross-and-blue-shield-federal-employee-program-fep-keeps-medical-premiums

Cigna Healthcare. (2024). Chiropractic care (CPG 278): Cigna medical coverage policy–therapy services chiropractic care. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/cpg278_chiropractic_care.pdf

Ernst, E., & Canter, P. H. (2006). A systematic review of systematic reviews of spinal manipulation. Journal of the Royal Society of Medicine, 99(4), 192–196. https://doi.org/10.1258/jrsm.99.4.192

Ernst, E. (2008). Chiropractic: A critical evaluation. Journal of Pain and Symptom Management, 35(5), 544–562. https://doi.org/10.1016/j.jpainsymman.2007.07.004

Gleberzon, B., Lameris, M., Schmidt, C., & O'Grady, J. (2013). On vaccination & chiropractic: When ideology, history, perception, politics and jurisprudence collide. The Journal of the Canadian Chiropractic Association, 57(3), 205. https://pmc.ncbi.nlm.nih.gov/articles/PMC3743646/

Marcon, A. R., Murdoch, B., & Caulfield, T. (2019). The “subluxation” issue: An analysis of chiropractic clinic websites. Archives of Physiotherapy, 9(1), Article 4. https://doi.org/10.1186/s40945-019-0064-5

Medicare. (2019). Coverage for chiropractic services. https://www.medicare.gov/coverage/chiropractic-services

National Center for Complementary and Integrative Health. (2019, April). Chiropractic: In depth. NCCIH. https://www.nccih.nih.gov/health/chiropractic-in-depth

Pollard, H. (2021). Reframing a debate in chiropractic. Chiropractic & Manual Therapies, 29(1), Article 4. https://doi.org/10.1186/s12998-021-00401-5

UnitedHealthcare. (2024). The summary of benefits and coverage (SBC). https://www.uhc.com/ifp/sbc.54332NC0030032-01.en.2024