Chiropractic Care in Delaware: Coverage and Access Guide

Chiropractic services in Delaware are covered under Medicaid, Medicare, and most private insurance plans, but the details depend on the type of coverage and provider network. This guide explains what is included, what is excluded, and the steps you need to take to use your benefits.

 
Medicaid in Delaware

Delaware Medicaid covers chiropractic care for both adults and children under specific conditions.

Adults:

• Manual spinal manipulation is covered when it is medically necessary.
• Coverage is primarily for treatment of spinal subluxation and related neuromusculoskeletal conditions.

Children under 21:

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

Requirements:

• The chiropractor must be a Delaware Medicaid-enrolled provider.
• A diagnosis and treatment plan are required for approval.
• Some cases may require prior authorization for extended care.

Visit Limits:

• Adults typically have a cap of approximately 12–20 visits per year, unless more are approved for medical necessity.
• EPSDT for children allows medically necessary care without a strict annual cap.

Not Covered:

• Routine maintenance or wellness-only adjustments.
• Massage therapy and acupuncture unless specifically listed as part of a managed care plan.
   

Medicare

Medicare Part B applies to Delaware as in all states:

• Covers only manual spinal manipulation to correct vertebral subluxation.
• Does not cover X-rays ordered by the chiropractor, massage, or preventive/wellness adjustments.
• Requires documentation of subluxation and medical necessity for every visit.
• Patients pay 20 percent coinsurance after the Part B deductible.
   

Private Insurance and Marketplace Plans

Delaware regulates most private insurance through state mandates that require plans to offer coverage for essential musculoskeletal care, which often includes chiropractic treatment.

What is typically covered:

• Manual spinal manipulation and evaluation when medically necessary.
• Treatment must show improvement or management of a diagnosed condition.

Visit Limits:

• Most plans cover 10–20 visits per year.
• Some plans allow more if progress and medical necessity are documented.

Requirements:

• HMO plans usually require a referral from a primary care physician.
• PPO plans may allow self-referral but still require medical necessity documentation.
• Prior authorization may be needed for extended or ongoing care.

Not Covered:

• Maintenance or wellness-only adjustments.
• Alternative therapies unless explicitly included in the plan.
   

Network Rules in Delaware

HMO Plans:

• Chiropractic visits must be with in-network providers to be covered.
• Out-of-network chiropractors are not paid unless no in-network provider exists and the plan authorizes the visit.

PPO Plans:

• In-network chiropractors are covered at the standard cost-sharing rate.
• Out-of-network providers may be partially covered, but patients may pay more and be balance-billed.

Medicaid:

• Only Medicaid-approved chiropractors are eligible for payment.
• Out-of-network or non-enrolled chiropractors are not covered.

Medicare:

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

Steps for Delaware Residents

If you have Medicaid:

• Choose a chiropractor who is enrolled with Delaware Medicaid.
• Ensure a diagnosis and treatment plan are on file.
• Request prior authorization if extended care is needed beyond the standard visit limit.

If you are on Medicare:

• Confirm that your chiropractor accepts Medicare assignment.
• Ensure subluxation and medical necessity are documented each visit.

If you have private insurance:

• Check your plan’s Summary of Benefits to confirm chiropractic coverage.
• Use an in-network chiropractor to avoid denied claims.
• Get a referral if required by your plan type.
• Be aware of the annual visit limit and request additional visits with supporting documentation if needed.
   

Key Points for Delaware Residents

• Medicaid covers chiropractic care for both adults and children when medically necessary.
• Children under EPSDT have access to expanded benefits without strict visit caps.
• Medicare covers only manual spinal manipulation for subluxation.
• Most private insurance plans include chiropractic care with annual visit limits and medical necessity requirements.
• In-network chiropractors are essential for full coverage under
• Medicaid and HMO plans.
• Documentation of diagnosis and treatment progress is required under all plan types.