Chinese
EnglishAll residents—whether patients, providers, or front desk staff—can use this guide as a one-stop reference for chiropractic care coverage in Alaska, broken down by insurance type, eligibility, service limits, and network policies.
Medicaid in Alaska
Adults:
Chiropractic services are not covered for most Medicaid adults in Alaska, except for those who are Medicare recipients (dual-eligible). In those cases, Alaska Medicaid pays secondary to Medicare for services Medicare allows.
(Alaska State Legislature, AWS Alaska)
Children (Under Age 21):
Covered under EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) if deemed medically necessary via referral.
Coverage includes up to 12 spinal manipulations per calendar year, plus one chiropractic X‑ray exam.
(Wikipedia, State of Alaska | Department of Health)
What Is Covered:
Manual spinal adjustments (manipulations) to correct subluxation.
One chiropractic X‑ray per year.
Evaluation and follow-up if ordered under EPSDT.
What Is Not Covered:
Any chiropractic services for adults under Medicaid, except for Medicare recipients.
Acupuncture, massage, or wellness-only/maintenance adjustments.
Requirements:
Children require EPSDT physician referral and prior authorization for under-six recipients.
(Alaska State Legislature, Alaska State Legislature, Wikipedia)
Adult Medicare beneficiaries follow Medicare medical necessity rules; no separate Medicaid authorization needed.
Visit Limits:
Children under Medicaid: maximum 12 adjustments/year and one X-ray.
Adult Medicare recipients: limits follow Medicare guidelines.
Medicare
Covered Services:
Manual spinal manipulation only, to correct vertebral subluxation.
Limitations:
Chiropractic X‑rays, massages, acupuncture, or maintenance care are not covered.
Medical necessity must be documented.
Costs:
20% coinsurance after Part B deductible.
Chiropractors must document subluxation and medical necessity.
Private Insurance (Individual, Small‑Group, Marketplace Plans)
State Benchmark & Mandates:
Chiropractic care is not an ACA-required essential health benefit in Alaska by default.
However, as of January 1, 2026, Alaska’s benchmark plan will expand chiropractic coverage to 20 visits/yearfor individual and small group plans regulated by the state.
(Alaska State Legislature, Alaska CCN, Alaska Department of Commerce)
Large-group and self-insured employer plans are not required to follow state-mandated chiropractic coverage.
What Is Covered:
Typically medically-necessary spinal manipulation.
May include chiropractic evaluations and co-management, depending on plan.
What Is Not Covered:
Maintenance or wellness-only care.
Alternative therapies (massage, unless medically necessary).
Visit Limits:
Beginning 2026: up to 20 chiropractic visits/year under state-regulated plans.
Prior to that: varied, often 10–12 visits/year.
Requirements:
Most plans require referrals and/or pre-authorization.
Coverage dependent on provider network status.
In‑Network vs. Out‑of‑Network Chiropractors
HMO Plans:
Patients may choose their chiropractor without prior approval, but must send a report within 10 days to their health plan.
After 30 days, if no improvement, treatment must be referred back to the health plan for possible concurrent care.
Only two maintenance visits/month are allowed once stabilized, unless a third chiropractor review is done.
(Justia Law, State of Alaska | Department of Health, healthinsurance.org, Alaska State Legislature)
Out-of-network chiropractors may be allowed, but the treating chiropractor must still follow the reporting process and be licensed.
PPO Plans:
Alaska has historically required that out-of-network providers be paid at least at the 80th percentile of billed charges. This regulation was set to expire in 2024 but is currently under legal challenge.
(Alaska Public Media)
This rule provides a minimum reimbursement guarantee to out-of-network providers and protects patients from excessive balance billing when their insurer pays less.
Medicare & Medicaid:
Medicare: chiropractors must accept Medicare assignment to be considered in-network; otherwise patients may pay upfront.
Medicaid: only Medicaid-enrolled providers are covered.
Chiropractic Service Oversight and Quality Provisions
Alaska statute allows patients to choose a licensed chiropractor without needing prior approval.
Chiropractors must submit reports if treatment continues beyond 30 days; if stabilization occurs, preventive visits are limited to two per month unless third-party review is requested.
(Justia Law)
These rules aim to ensure effective care and prevent unnecessary maintenance treatment.
Summary by Insurance Type
Insurance Type
Chiropractic Coverage Details
Medicaid – Adults
Not covered unless Medicare-eligible (dual).
Medicaid – Children (<21, EPSDT)
Up to 12 adjustments/year + 1 X-ray; referral & prior authorization required (under age 6).
Medicare Part B
Only spinal manipulation for subluxation; 20% coinsurance after deductible; no X-rays, massage, or wellness care.
Individual/Small Group Plans
Beginning 2026, covers up to 20 visits/year; must be medically necessary; referrals and pre-authorizations often required.
Large Group / Self-Insured
Coverage varies by plan; state mandates do not apply.
HMO Plans (private)
Patients may choose any licensed chiropractor; must report and follow 30-day review; limited to two preventive visits/month.
PPO Plans (private)
Out-of-network reimbursement historically has minimum threshold; patients still responsible for higher coinsurance and balance billing risk.
Guidance for Alaskans Seeking Chiropractic Care
If you have Medicaid:
Under 21? Ask your doctor for an EPSDT referral.
Adult with Medicare? Ensure your chiropractor accepts Medicare assignment.
If you have Medicare:
Verify the chiropractor accepts Medicare assignment.
Be prepared to document subluxation and need for manipulation.
If you have private or Marketplace insurance:
Confirm chiropractic coverage in your benefits.
Use an in-network chiropractor whenever possible.
Understand your visit limits (especially under the new 20-visit rule starting 2026).
Get any required referrals or pre-authorizations.
If you have a PPO or out-of-network benefit:
Be aware of your plan’s reimbursement rates.
Ask about potential balance billing and reimbursement rules.
If you are uninsured:
No state or federal chiropractic benefits are available unless eligible for Medicaid EPSDT or Medicare.
Key Legal References
Alaska Medicaid regulations (§7 AAC 110.120 and §7 AAC 110.210) define coverage for chiropractic and EPSDT limits.
(Alaska State Legislature, healthinsurance.org, AWS Alaska, Alaska Public Media, Legal Information Institute)
Alaska Statutes §21.86.075 mandates patient freedom to choose their chiropractor and oversight rules during extended treatment.
(Justia Law)
Alaska Division of Insurance approved benchmark plan update effective January 1, 2026, expanding chiropractic visits coverage.
(Alaska Department of Commerce)
Case coverage of state minimum out-of-network payment rules subject to repeal and litigation.
(Alaska Public Media, Anchorage Daily News)
