Chiropractic care is useful as a treatment for many conditions, including low back pain [1]. LBP is one of the leading reasons why Americans visit medical practitioners, as well as a significant contributor to opioid use in the country [1]. Despite chiropractic care’s demonstrated efficacy in helping sufferers of LBP, not all health insurance plans in the United States cover chiropractic care, and those that do tend to do so sparingly [2]. This article will explore differences in chiropractic care coverage across health insurance plans, as well as the adverse effects of limited coverage on patients.
Most health insurance plans include some coverage for chiropractic care [3]. Heyward et al. conducted a survey of 15 commercial, 15 Medicare Advantage Health, and 15 Medicaid plans [2]. The plans they surveyed represented more than 50% of insured people in the US [2]. On the whole, all three types of plans tend to cover chiropractic care [2].
Despite this broad-based coverage, benefits could be subject to certain limits that reduce patient access to chiropractic services [2]. Commercial insurers and Medicaid tend to subject patients to visit limits for chiropractic care [2]. Instead of visit limits, other Medicaid plans may require that beneficiaries receive prior authorization, meet certain conditions, or acquire a referral before visiting a chiropractor [2].
Meanwhile, Medicare only allows beneficiaries to receive chiropractic coverage if they need to fix a vertebral subluxation [4]. Any other form of chiropractic care, as well as any examinations that the chiropractor orders, will not be covered [4]. This coverage strategy is incoherent, given how chiropractic care for a variety of conditions is associated with reduced opioid-associated disability, lower medical costs, and faster recovery, among many other benefits [5].
Costs varied across insurers as well. Medicare Advantage requires beneficiaries to pay a median $20 co-payment for in-network care or a 35% co-insurance fee for out-of-network care [2]. By comparison, commercial insurers place a significantly higher out-of-pocket cost on beneficiaries. Patients pay on average a $60 co-payment per visit if their provider is in-network or a 50% co-insurance fee for out-of-network providers [2]. After meeting their deductible, Medicare beneficiaries pay 20% of the Medicare-Approved Amount for chiropractic services [4].
Evidently, there are major deficiencies in chiropractic care coverage across US health insurance plans. Given the many advantages of chiropractic care, these shortcomings are significant. Davis et al. estimated that, for every 1,000 Medicare beneficiaries, reduced access to chiropractic care results in an increased cost of $114,967 [6]. Furthermore, chiropractic care has helped dampen the opioid pandemic by providing patients with nonpharmacological alternatives to back and neck problems [3]. By reducing access to chiropractic care, efforts to combat opioid overuse may be impaired.
Because of heightened costs, visit limits, and other obstacles, many people who may benefit from chiropractic care cannot access it [1]. To address this issue, researchers recommend pushing for nonpharmacological care, possibly through financial incentives, instructive advocacy, policymaking, or a combination of approaches [1]. By legitimizing nonpharmacological options as frontline treatments for chronic conditions, chiropractic care may become more broadly insured across the US [1].
References
[1] C. M. Goertz and S. Z. George, “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain–Time for a Change,” JAMA Network Open, vol. 1, no. 6, p. 1-3, October 2018. [Online]. Available: DOI: 10.1001/jamanetworkopen.2018.3037.
[2] J. Heyward et al., “Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers,” JAMA Network Open, vol. 1, no. 6, p. 1-14, October 2018. [Online]. Available: DOI: 10.1001/jamanetworkopen.2018.3044.
[3] B. J. Eovaldi and B. McAlpine, “Increased Utilization of Spinal Manipulation by Chiropractors to Tackle the Opioid Epidemic,” Medical Care, vol. 59, no. 12, p. 1039-1041, December 2021. [Online]. Available: DOI: 10.1097/MLR.0000000000001633.
[4] “Chiropractic services,” Medicare. [Online]. Available: https://www.medicare.gov/coverage/chiropractic-services.
[5] R. A. Leach, “Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs,” Journal of Chiropractic Humanities, vol. 27, no. C, p. 29-36, December 2020. [Online]. Available: DOI: 10.1016/j.echu.2020.10.002.
[6] M. Davis et al., “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults,” Journal of Manipulative and Physiological Therapeutics, vol. 44, no. 5, p. 353-362, June 2021. [Online]. Available: DOI: 10.1016/j.jmpt.2021.05.002.