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Chiropractic care under the Affordable Care Act

Coverage for chiropractic care is uniform and simplified following implementation of the Affordable Care Act

by Tony Novak, CPA, MBA, MT    follow @tonynovak

Prior to the implementation of the Affordable Care Act in 2014, the methods of covering chiropractic care varied from one health plan to the next. The most common approach was to set a maximum overall dollar benefit for chiropractic care. For example some large Blue Cross pland covered chiropractic care up to $1,500 per year. Now, coverage under post-reform health insurance plans is standardized regardless of the insurance company or policy you choose. There are some exceptions like self-insured or grandfathered health plans that are not subject to these new rules, but this article focuses on the most common scenarios under today's health plans.

There are three ways that chiropractic care will be covered now in 2014 and beyond:

1. As an essential benefit under the rehabilitative and habilitative services provision of the law. A plan member is entitled to coverage for up to 30 visits per year. there is no specified maximum dollar benefit, but payments are likely limited to prevailing rates are determined by the insurer. These benefits are usually subject to a policy deductible and a co-payment for each visit.

2. As an essential benefit under the preventative and wellness services provision of the law. A plan member is entitled to this coverage but an insurer may limit the frequency of the benefit, for example, to up to 2 visits per year. Again, there is no specified maximum dollar benefit, but payments are likely limited to prevailing rates are determined by the insurer.

3. As a specified covered benefit in a supplemental insurance policy. These benefits are usually not subject to deductible or co-payment. As an example, the most popular supplemental insurance here at Freedom Benefits is Core Health Insurance that provides a benefit of $65 to $80 per visit for up to 10 doctors visits or 3 wellness visits per year.

The Affordable Care Act Section 2706 specifies that insurers can not discriminate against chiropractic care that is utilized in the treatment of a mandated covered benefit. In that respect, chiropractic care is treated in the same way as other types of medical care. This section of the law states that a "group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law." This single section of the law is cited the most dramatic change in coverage for chiropractic services in the history of the profession in the U.S.

The American Chiropractic Association also cites two other provisions of the Affordable Care Act (Section 3512 Community Health Teams and Section 5101 National Health Care Workforce Commission) as having potential to change chiropractic coverage over the long term, but discussions are excluded from this article because they have no immediate impact for most readers.

One major criticism of the new national health insurance law is that a greater portion of ordinary health care expense is pushed to the policyholder as an out-of-pocket cost. These out-of-pocket costs can add up to thousands of dollars in additional expense each year even when a person has insurance and the expenses are "covered" under the policy. The typical out-of-pocket is around $5,000 but could go above $10,000 per year in some family policies. It is important for policyholders to understand that under the new policies "Covered" might mean that you are still paying the full cost. This extra risk is reduced by adding a supplemental insurance policy. Other options for covering out-of-pocket expenses include Health Savings Accounts, Health Reimbursement Arrangements and Flexible Spending Accounts. These options are handled for small businesses by FreedomBenefits.org. help with the Affordable Care Act

Do you have a story to share about how your chiropractic care is being covered or not covered? We'd love to hear. Just write to onlineadviser@freedombenefits.net. Since this topic is brand new, we hope to use some real examples (without names of course) in future consumer help articles.

 


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Opinions expressed are the sole responsibility of the author Tony Novak and do not represent the opinion of any other person, company or entity mentioned. Information is from sources believed to be reliable but cannot be guaranteed. Freedom Benefits is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the commercial companies listed on this site.