Does Medicare Pay for Naturopathic Doctors?
Learn about Medicare's stance on naturopathic doctors and paths to incorporating natural health into your care.
Medicare is a federal health insurance program primarily for individuals aged 65 or older, younger people with specific disabilities, or those with permanent kidney failure or amyotrophic lateral sclerosis (ALS). Many people rely on this program for their healthcare needs. Naturopathic doctors (NDs) are healthcare professionals who focus on holistic and natural approaches to health, leading many beneficiaries to question if their services are covered by Medicare.
Understanding Naturopathic Medicine
Naturopathic medicine emphasizes prevention and the body’s self-healing capabilities through natural therapies. Naturopathic doctors (NDs) treat the whole person, addressing the root causes of illness. Common modalities include clinical nutrition, herbal medicine, lifestyle counseling, acupuncture, and homeopathy. Licensed NDs complete a four-year, graduate-level program at an accredited naturopathic medical school and pass professional board exams.
Medicare Coverage for Naturopathic Doctors
Original Medicare (Part A and Part B) generally does not cover services provided by naturopathic doctors. This exclusion stems from federal statutes defining eligible providers. Medicare covers services from federally recognized and licensed providers, such as medical doctors (MDs), doctors of osteopathic medicine (DOs), physician assistants (PAs), and nurse practitioners (NPs).
Naturopathic doctors are not recognized as eligible providers under federal guidelines for direct billing. This means an ND cannot enroll in Medicare as a participating provider. Consequently, services rendered directly by a naturopathic doctor are not reimbursable by Original Medicare, requiring beneficiaries to seek alternative payment. This gap in coverage means beneficiaries often face disruptions or increased out-of-pocket costs when they become Medicare eligible.
Medicare Coverage for Related Healthcare Services
While direct services from naturopathic doctors are not covered, certain recommended tests or treatments might be. For instance, laboratory tests or imaging scans can be covered. Coverage is contingent upon tests being ordered by a Medicare-recognized provider (e.g., MD or DO) and performed by a Medicare-approved facility. The key distinction for coverage is the Medicare eligibility of the ordering or performing provider, not the naturopathic doctor’s recommendation.
Medicare offers limited coverage for some other complementary and alternative medicine (CAM) services. Chiropractic services are covered by Medicare Part B for manual spinal manipulation to correct a vertebral subluxation. This coverage applies only to manual manipulation, not other services like X-rays or massage therapy. Medicare Part B also covers acupuncture for chronic low back pain (lasting 12 weeks or longer with no known cause). Coverage is limited to up to 12 sessions within a 90-day period, with an additional 8 sessions possible if improvement is shown (up to a maximum of 20 treatments per year), and must be performed by a Medicare-recognized doctor or other healthcare provider (e.g., nurse practitioner or physician assistant) who meets credentialing requirements.
Alternative Paths to Naturopathic Care
Since Original Medicare generally does not cover naturopathic doctors, beneficiaries often explore other avenues to access these services. Private health insurance plans may offer coverage for naturopathic care, varying by policy and state regulations. Individuals should contact their insurance provider to inquire about benefits, including deductibles, copayments, or visit limitations.
Medicare Advantage Plans (Medicare Part C) are another option, offered by private companies approved by Medicare. These plans bundle Original Medicare benefits and often include additional benefits like vision, hearing, or dental care. While some Medicare Advantage plans have offered limited coverage for alternative therapies, including naturopathic services, this varies widely by plan, location, and can change annually. Review the plan’s Summary of Benefits or contact the insurer to determine if naturopathic services are included. Many also pay for naturopathic care out-of-pocket; some NDs may offer sliding scale fees or package deals.