Equine therapy is rarely covered by standard health insurance. Most major insurers classify it as experimental or unproven, which means claims are routinely denied. However, there are narrow exceptions depending on your insurance type, your diagnosis, and how the therapy is billed.
Why Most Insurers Deny Coverage
The core problem is classification. Aetna’s clinical policy bulletin, which is representative of how most large insurers handle this, labels hippotherapy and equine-assisted therapy as “experimental, investigational, or unproven” for all indications. The specific billing code for equine therapy (S8940) is explicitly listed as not covered. Other major commercial insurers follow similar logic: without enough large-scale clinical trials meeting their evidence thresholds, equine therapy doesn’t qualify as a standard covered benefit.
This applies whether you’re seeking hippotherapy for a physical condition or equine-assisted psychotherapy for a mental health concern. The denial isn’t about your diagnosis. It’s about the treatment method itself.
Hippotherapy vs. Equine-Assisted Psychotherapy
These two forms of equine therapy serve different purposes, involve different professionals, and face slightly different insurance landscapes. Understanding the distinction matters if you’re exploring any path to coverage.
Hippotherapy is a physical rehabilitation approach. A licensed physical, occupational, or speech therapist uses the movement of a horse’s gait to work on balance, coordination, muscle strength, and sensory processing. It’s commonly used for conditions like cerebral palsy, multiple sclerosis, and stroke recovery. Because a licensed rehab therapist delivers the treatment, some families have had success getting reimbursement when the therapist bills for the underlying service (occupational therapy or physical therapy) rather than for equine therapy specifically. This workaround depends entirely on the provider’s billing practices and your insurer’s willingness to pay, and it’s not guaranteed.
Equine-assisted psychotherapy (EAP) is led by a licensed mental health professional alongside a horse specialist. The focus is emotional regulation, self-esteem, trauma processing, and social skills. EAP is frequently used with children who have behavioral or emotional challenges and with adults dealing with PTSD or anxiety. Insurance coverage for EAP is even harder to obtain than for hippotherapy because there’s no underlying physical therapy code to fall back on.
TRICARE, Medicaid, and Government Programs
TRICARE explicitly excludes hippotherapy from its basic program, calling it an “exercise program.” The one exception is TRICARE’s Extended Care Health Option (ECHO), which covers hippotherapy only for beneficiaries with a primary or secondary diagnosis of multiple sclerosis or cerebral palsy. Equine-assisted psychotherapy is excluded entirely under TRICARE, with no exceptions.
Medicaid coverage varies dramatically by state. Colorado, for example, includes “adaptive therapeutic equine activities” as a covered service under several of its home and community-based waivers. The Children’s Extensive Support waiver covers it for children with developmental disabilities up to age 17 who meet a certain level of care. The Supported Living Services waiver covers it for adults 18 and older with developmental disabilities. These are not open to everyone on Medicaid in Colorado. You must be enrolled in the specific waiver program and meet its eligibility criteria. Other states may have similar waiver programs, but there is no national Medicaid standard requiring equine therapy coverage.
The Department of Veterans Affairs runs an Adaptive Sports Grant Program that funds organizations providing equine therapy to veterans and service members with disabilities. In a recent funding cycle, the VA made $1.5 million available for these grants, with individual awards up to $750,000. The money goes to organizations, not directly to veterans, but it means some VA-affiliated equine therapy programs can offer services at no cost to eligible participants.
Using HSA or FSA Funds
Health savings accounts and flexible spending accounts can be used for “qualified medical expenses” as defined by IRS rules. The IRS doesn’t specifically mention equine therapy on its approved list, but it also doesn’t explicitly exclude it. Eligibility hinges on whether the expense qualifies as “medical care” under the tax code, which generally means it must be primarily for the diagnosis, cure, treatment, or prevention of disease.
To use HSA or FSA funds for equine therapy, you’ll need documentation from a licensed healthcare provider stating that the therapy is medically necessary for a specific condition. For an FSA, you must provide a written statement from an independent third party confirming the expense was incurred and its amount, plus a statement that it hasn’t been reimbursed by any other health plan. Getting a letter of medical necessity from your doctor before starting treatment is the safest approach. Some HSA/FSA administrators may still reject the claim, so checking with your plan administrator in advance saves headaches.
What Sessions Actually Cost
Without insurance, you’re looking at a wide range depending on the type of equine therapy. Hippotherapy, because it involves a licensed medical professional, tends to be the most expensive at $80 to $250 per session. Equine-assisted psychotherapy runs $75 to $200 per session. Therapeutic riding programs are more affordable at $40 to $100 per lesson, and groundwork-based therapy (where you work with horses on the ground rather than riding) costs $40 to $90. Group sessions typically run 20 to 40 percent less than individual sessions.
For someone attending weekly sessions, annual out-of-pocket costs can reach $4,000 to $13,000 for hippotherapy or $3,900 to $10,400 for EAP. That’s a significant expense, especially for families managing a chronic condition alongside other medical bills.
Ways to Reduce the Cost
Many equine therapy centers are nonprofit organizations that offer sliding-scale fees based on income. Some maintain scholarship funds specifically for families who can’t afford full rates. Asking the center directly about financial assistance is always worth doing, as these programs aren’t always advertised on their websites.
If your child has a developmental disability, check whether your state’s Medicaid waiver programs include equine activities. Your state’s developmental disabilities agency or Medicaid office can tell you which waivers are available and whether you qualify. Veterans should contact their local VA office or look into programs funded through the VA’s adaptive sports grants, which can provide equine therapy at no charge.
For everyone else, the most realistic path is combining a letter of medical necessity from your doctor with HSA or FSA funds. Even if your health insurance won’t cover the sessions directly, paying with pre-tax dollars through an HSA or FSA effectively reduces the cost by your marginal tax rate, which for many families means 22 to 32 percent savings.