U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief No. 235 January 2016

Insurance Coverage for Complementary Health Approaches 

Among Adult Users: United States, 2002 and 2012

Richard L. Nahin, Ph.D., M.P.H.; Patricia M. Barnes, M.A.; and Barbara J. Stussman, B.A.

Key findings 

Data from the 2002 and 

2012 National Health 

Interview Surveys

● Between 2002 and 2012, 

the use of acupuncture, 

chiropractic, and massage 

therapy increased among 

adults who did not have 

health insurance coverage for 

these complementary health 

approaches. No change in use 

was observed among those 

who had coverage for these 

approaches.

● While 60% of adults 

who saw a practitioner for 

chiropractic had at least some 

health insurance coverage 

for this approach, far fewer 

adults seeing a practitioner for 

acupuncture (25%) or massage 

therapy (15%) had coverage for 

these approaches.

● Adults who saw practitioners 

for acupuncture and 

chiropractic—and had health 

insurance coverage for these 

approaches—were more likely 

to have partial than complete 

coverage.

Between 30% and 40% of U.S. adults have used complementary health 

approaches in a given year (1–4). According to national surveys, the type of 

health insurance an individual holds affects whether they use these approaches 

(2–5). Health insurance coverage for individual complementary health 

approaches, however, has not been as widely studied. The most recent national 

data on this topic was released nearly 20 years ago (1). Recognizing that health 

insurance benefits have changed over this period, this report presents estimates 

of insurance coverage among adult users of the three most commonly licensed 

practitioner-based complementary health approaches in the United States 

(acupuncture, chiropractic, and massage therapy) (6), using data from the 2002 

and 2012 National Health Interview Surveys (NHIS). 

Keywords: health insurance • National Health Interview Survey (NHIS)

The use of acupuncture, chiropractic, and massage therapy 

increased between 2002 and 2012.

■ ■

Figure 1. Age-adjusted percentages of adults who saw a practitioner for acupuncture, chiropractic, and massage therapy: United States, 2002 and 2012

 

1

Significant difference between 2002 and 2012 (p < 0.05). 2

Significantly different from massage in 2002 (p < 0.05). 3

Significantly different from massage in 2012 (p < 0.05). 4

Significantly different from acupuncture in 2002 and massage in 2002 (p < 0.05). 5

Significantly different from acupuncture in 2012 and massage in 2012 (p < 0.05).

NOTES: Denominator is all adults. Numerator is all adults who saw a practitioner for the given approach.

SOURCE: CDC/NCHS, National Health Interview Surveys, 2002 and 2012.
NCHS Data Brief ■ No. 235 ■ January 2016

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● In both 2002 and 2012, a significantly larger percentage of adults saw a practitioner for 

chiropractic (7.5% in 2002 and 8.3% in 2012) than for acupuncture (1.1% in 2002 and 1.5% 

in 2012) or massage therapy (5.0% in 2002 and 6.9% in 2012) (Figure 1). 

● In both 2002 and 2012, a significantly larger percentage of adults saw a practitioner for 

massage therapy (5.0% in 2002 and 6.9% in 2012) than for acupuncture (1.1% in 2002 and 

1.5% in 2012). 

● For each of the three practitioner-based complementary health approaches examined, there 

was a significant increase in use between 2002 and 2012. The absolute increase in use 

ranged from 1.6% for massage therapy to 0.4% for acupuncture. 

Although increases were observed in the percentage of adults who saw 

a practitioner for acupuncture, chiropractic, or massage therapy and did 

not have health insurance coverage for these visits, no changes were 

observed among those who saw a practitioner and had coverage for these 

complementary health approaches.

● In both 2002 and 2012, most adults who saw a practitioner for acupuncture or massage 

therapy did not have health insurance coverage for these complementary health approaches 

(p < 0.05). However, most adults who saw a practitioner for chiropractic had coverage for 

this approach (p < 0.05) (Figure 2).

● Between 2002 and 2012, there was a significant increase in the percentage of adults who 

saw a practitioner for acupuncture but did not have health insurance coverage for this 

approach (0.6% in 2002 and 1.1% in 2012). No difference was observed between 2002 and 

2012 in the percentage of adults who saw a practitioner for acupuncture and had health 

insurance coverage (0.3% in 2002 and 0.4% in 2012) for this approach.

● Between 2002 and 2012, there was a significant increase in the percentage of adults who 

saw a practitioner for chiropractic but did not have health insurance coverage for this 

approach (2.2% in 2002 and 3.3% in 2012). No difference was observed between 2002 

(4.8%) and 2012 (5.1%) in the percentage of adults who saw a practitioner for chiropractic 

and had coverage for this approach.

● Between 2002 and 2012, there was a significant increase in the percentage of adults who 

saw a practitioner for massage therapy but did not have health insurance coverage for this 

approach (3.8% in 2002 and 5.8% in 2012). No difference was observed between 2002 

(0.7%) and 2012 (1.0%) in the percentage of adults who saw a practitioner for massage 

therapy and had coverage for this approach.
NCHS Data Brief ■ No. 235 ■ January 2016

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Figure 2. Age-adjusted percentages of adults who saw a practitioner for acupuncture, chiropractic, and massage therapy, 

by whether insurance covered any of the costs for the approach: United States, 2002 and 2012 

1

Significant difference between “had coverage” and “no coverage” (p < 0.05).

2

Significant difference between “no coverage” in 2002 and “no coverage” in 2012 (p < 0.05).

NOTES: Denominator is all adults. Numerator is based on questions that ask whether individuals had insurance coverage for the given approach and only 

incorporates “yes” (they had coverage) or “no” (they did not have coverage) responses. Other possible responses varied across survey years and were not plotted.

SOURCE: CDC/NCHS, National Health Interview Surveys, 2002 and 2012.
NCHS Data Brief ■ No. 235 ■ January 2016

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Adults who had health insurance coverage for acupuncture, chiropractic, 

or massage therapy were more likely to have partial than complete 

coverage.

● One-quarter of adults seeing a practitioner for acupuncture had health insurance coverage 

for this complementary health approach. These adults were significantly more likely to have 

partial (16.5%) than complete (8.5%) coverage (Figure 3). 

● About 60% of adults seeing a practitioner for chiropractic reported having either partial or 

complete health insurance coverage for this approach. These adults were significantly more 

likely to report having partial (41.4%) than complete (18.7%) coverage. 

● Only 15% of adults seeing a practitioner for massage therapy had either partial or complete 

health insurance coverage for this approach.

 

Figure 3. Age-adjusted percentages of adults seeing a practitioner for acupuncture, chiropractic, or massage therapy who 

reported that health insurance covered all, some, or none of the costs of using the approach: United States, 2012

1

Significant difference between complete coverage and partial coverage (p < 0.05).

NOTE: Denominator is all adults who saw a practitioner for the given complementary health approach.

SOURCE: CDC/NCHS, National Health Interview Surveys, 2002 and 2012.
NCHS Data Brief ■ No. 235 ■ January 2016

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Summary

While most adults who saw a practitioner for chiropractic had health insurance coverage for this 

complementary health approach, most adults who saw a practitioner for acupuncture and massage 

therapy did not have coverage for these approaches, according to data from the 2002 and 2012 

NHIS. For acupuncture and chiropractic, adults with health insurance coverage were more likely 

to have only partial coverage than complete coverage. 

Increased use of acupuncture, chiropractic, and massage therapy between 2002 and 2012 was 

previously noted (4). There was a significant increase in the percentage of adults who saw a 

practitioner for acupuncture, chiropractic, or massage therapy but did not have health insurance 

coverage for these approaches. No change in use was observed among those with insurance 

coverage. These data suggest that consumers are increasingly willing to pay out of pocket for the 

use of acupuncture, chiropractic, and massage.

Prior to this report, the only national data on insurance coverage for complementary health 

approaches were based on a 1997 telephone survey using random-digit dialing (1). Similar to the 

current data, Eisenberg et al. (1) found that most individuals using chiropractic had at least some 

health insurance coverage for this approach, while most individuals using massage therapy and 

acupuncture did not have coverage. Both the current report and Eisenberg et al. (1) found that 

coverage was more likely to be partial than complete. The amount and type of health insurance 

coverage for acupuncture, chiropractic, and massage therapy may change as state laws on 

coverage for these complementary health approaches continue to develop (7). 

Definitions

Acupuncture: A family of procedures involving stimulation of anatomical points on the body 

by a variety of techniques. In its classical form, acupuncture is a characteristic component of 

traditional Chinese medicine.

Chiropractic: Involves the adjustment of the spine and joints to influence the body’s nervous 

system and natural defense mechanisms to alleviate pain and improve general health. Chiropractic 

is primarily used to treat back problems, headaches, nerve inflammation, muscle spasms, and 

other injuries and traumas.

Level of health insurance coverage: Level of coverage for complementary health approaches was 

determined from responses to the following questions: “During the past 12 months, were any of 

the costs of seeing a practitioner for [therapy] covered by health insurance?” and “During the 

past 12 months, did your health insurance cover all of the cost or just some of the cost of seeing a 

practitioner for [therapy]?”

Massage: Massage therapists manipulate muscle and connective tissue to enhance the function of 

these tissues and to promote relaxation and well-being.

Practitioner-based complementary health approaches: Complementary health approaches for 

which the services of a practitioner are generally necessary. Examples include acupuncture, 

chiropractic, and massage therapy.
NCHS Data Brief ■ No. 235 ■ January 2016

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Data source and methods

The estimates in this report are based on data from the 2002 and 2012 NHIS Adult 

Complementary and Alternative Medicine Supplements. The processes used to develop the 

supplements are described elsewhere (8). NHIS is a nationally representative, cross-sectional 

household interview survey that is fielded continuously by the Centers for Disease Control and 

Prevention’s (CDC) National Center for Health Statistics (NCHS) and produces annual estimates 

of the health of the U.S. civilian noninstitutionalized population. Interviews are conducted in 

respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. 

In 2002 and 2012, information was collected on a total of 31,044 and 34,525 adults aged 18 and 

over, respectively.

Analyses were conducted using SAS-callable SUDAAN version, 11.0.0 (9), which accounts 

for the complex sample design of NHIS. All estimates were weighted using the annual sample 

adult weights for their respective survey year. Estimates were age-adjusted, which allows 

for comparison across years of various sociodemographic subgroups that may have different 

age distributions. Age adjustment and data weighting procedures are described in more detail 

elsewhere (10). The Taylor series linearization method was chosen for estimation of standard 

errors. Differences between percentages were evaluated using two-sided significance tests at the 

0.05 level. 

About the authors

Richard L. Nahin and Barbara J. Stussman are with the National Institutes of Health, National 

Center for Complementary and Integrative Health. Patricia M. Barnes is with CDC’s National 

Center for Health Statistics, Research Data Center.

References

1. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends 

in alternative medicine use in the United States, 1990–1997: Results of a follow-up national 

survey. JAMA 280(18):1569–75. 1998.

2. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative 

medicine use among adults: United States, 2002. Advance data from vital and health statistics; no 

343. Hyattsville, MD: National Center for Health Statistics. 2004.

3. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults 

and children: United States, 2007. National health statistics reports; no 12. Hyattsville, MD: 

National Center for Health Statistics. 2008.

4. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health 

approaches among adults: United States, 2002–2012. National health statistics reports; no 79. 

Hyattsville, MD: National Center for Health Statistics. 2015.

5. Black LI, Clarke TC, Barnes PM, et al. Use of complementary health approaches among 

children aged 4–17 years in the United States: National Health Interview Survey, 2007–2012. 

National health statistics reports; no 78. Hyattsville, MD: National Center for Health Statistics. 

2015. 
NCHS Data Brief ■ No. 235 ■ January 2016

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6. Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, Van Rompay MI, Cooper RA. Credentialing 

complementary and alternative medical providers. Ann Intern Med 137(12):965–73. 2002. 

7. Fan AY. “Obamacare” covers fifty-four million Americans for acupuncture as Essential 

Healthcare Benefit. J Integr Med 12(4):390–3. 2014.

8. Stussman BJ, Bethell CD, Gray C, Nahin RL. Development of the adult and child 

complementary medicine questionnaires fielded on the National Health Interview Survey. BMC 

Complement Altern Med 13:328. 2013.

9. RTI International. SUDAAN (Release 11.0) [computer software]. 2009.

10. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health 

Interview Survey, 2006–2015. National Center for Health Statistics. Vital Health Stat 2(165). 

2014. 
NCHS Data Brief ■ No. 235 ■ January 2016

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Suggested citation

Nahin RL, Barnes PM, Stussman BJ. 

Insurance coverage for complementary 

health approaches among adult users: 

United States, 2002 and 2012. NCHS data 

brief, no 235. Hyattsville, MD: National 

Center for Health Statistics. 2016.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Research and Methodology

Nathaniel Schenker, Ph.D., Acting Director

Donald Malec, Ph.D., Associate Director 

for Science

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