Chiropractic Care in Connecticut: Complete Coverage Information

Connecticut offers chiropractic coverage through Medicaid (HUSKY Health), Medicare, and private insurance plans. This guide explains the details of what is covered, limits, and requirements for each type of insurance.

 
Medicaid (HUSKY Health)

Connecticut’s Medicaid program, known as HUSKY Health, includes chiropractic services for eligible members.

Adults:

• Chiropractic care is covered when medically necessary.
• Covered services include manual spinal manipulation and related evaluation and management.

Children under 21:

• Chiropractic treatment is included under the EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit.
• There are no strict visit limits for children if care is documented as medically necessary.

Visit Limits:

• For adults, HUSKY Health generally limits chiropractic visits to approximately 12 per calendar year unless additional visits are approved for medical necessity.
• Children can exceed the standard limit under EPSDT.

Requirements:

• Chiropractors must be enrolled with HUSKY Health to receive payment.
• A diagnosis and treatment plan must be documented.
  Prior authorization is required for some extended care.

Not Covered:

• Maintenance or wellness-only adjustments without a medical diagnosis.
• Massage therapy and acupuncture unless specifically included in the plan.

 
Medicare

Federal Medicare rules apply in Connecticut:

• Covers only manual spinal manipulation to correct vertebral subluxation.
• Does not cover X-rays ordered by chiropractors, massage therapy, or maintenance care.
• Patients pay 20 percent coinsurance after the Part B deductible.
• Chiropractors must document the subluxation and medical necessity at each visit.

 
Private Insurance and Marketplace Plans

Connecticut regulates most private health insurance through state law. The state requires many insurance plans to include coverage for chiropractic care as part of musculoskeletal treatment.

Typical Coverage:

• Spinal manipulation and related evaluations are covered when medically necessary.
• Most plans cover between 12 and 20 visits per year.
• Additional visits may be approved if there is documented improvement and a treatment plan.

Requirements:

• Many plans require a referral from a primary care physician, especially HMOs.
• Prior authorization is often required for extended treatment.

Not Covered:

• Routine maintenance or wellness adjustments without a diagnosis.
• Massage therapy unless the plan explicitly includes it.
   

Network Rules

HMO Plans:

• You must use an in-network chiropractor for coverage.
• Out-of-network visits are not covered unless pre-approved due to lack of in-network providers.

PPO Plans:

• In-network chiropractors are covered under standard cost-sharing.
• Out-of-network chiropractors may be covered at a lower reimbursement rate, and patients may pay the difference in charges.

Medicaid (HUSKY Health):

Only chiropractors enrolled with HUSKY Health are reimbursed.
Non-enrolled providers are not covered.

Medicare:

• Any chiropractor who accepts Medicare assignment is eligible to provide covered services.
• Patients may pay upfront if the chiropractor does not accept assignment.
   

Guidance for Connecticut Residents

If you have HUSKY Health:

• Find a chiropractor who is enrolled in HUSKY Health.
• Make sure the treatment plan and diagnosis are documented.
• For children, use the EPSDT program to access expanded benefits.

If you are on Medicare:

• Choose a chiropractor who accepts Medicare assignment.
• Ensure each visit documents vertebral subluxation and medical necessity.

If you have private insurance:

• Check your plan for chiropractic coverage and visit limits.
  Use an in-network chiropractor to avoid denied claims.
• Get a referral from your primary care physician if required.
  Be aware of the visit cap and request additional visits if medically necessary.
   

Key Points for Connecticut

• Medicaid (HUSKY Health) covers chiropractic care for both adults and children when medically necessary.
• Children have expanded access under EPSDT with no strict visit cap.
• Medicare covers only manual spinal manipulation for subluxation.
• Most private insurance plans include chiropractic benefits with visit limits and referral requirements.
• In-network chiropractors are essential for Medicaid and most HMO plans.