Does Medicare Pay for Holistic Doctors or Alternative Medicine
Medicare Benefits Solutions
Nov 17, 2022
If you’re battling chronic pain or a long-term illness, you may be searching for methods available to treat your condition outside of traditional medical interventions. If you qualify for Medicare due to age or disability, will alternative care be included in your benefits? This will depend on a variety of factors.
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Does Medicare Cover Alternative Treatments?
Original Medicare doesn’t normally cover alternative medicine therapies or holistic doctor services. However, acupuncture, chiropractic adjustments and nutritional counseling may be covered when you meet certain criteria such as having chronic back pain. Another option is to find a Medicare Advantage plan that offers additional health and wellness benefits.
TIP: Find out which plans offer coverage for chiropractic care and other alternative medicine services and compare them against your current Medicare benefits.
Overview of Traditional vs Alternative Medicine
In traditional medicine, your doctor responds to a health concern, formulates a diagnosis and prescribes a treatment or cure in the form of prescription drugs or medical procedures. Your doctor may refer you to a specialist with expertise in the area that requires medical attention.
The practice of alternative medicine addresses the whole or integrated system rather than its individual parts, based on the assertion that the various functions of the human body do not work in isolation. Holistic approaches include physical treatments like acupuncture and chiropractic care, nutritional supplements like vitamins and minerals, and psychological therapies like mindfulness and spiritual practices.
The holistic approach is associated with terms like integrative care, functional or alternative medicine, and complementary health.
Top 5 Holistic Doctor Specialities
An integrative medical doctor (MD) is fully licensed and combines conventional medical practices with holistic techniques.
A Doctor of Chiropractic Medicine (DC) is a hands-on practitioner with expertise in manipulating joints to mitigate pain and making adjustments to realign your spine.
A Doctor of Naturopathic Medicine (ND) combines traditional medical science, alternative methods and natural therapies.
An acupuncturist employs traditional Chinese techniques to rebalance energy in the body through the insertion of needles at select points.
A Doctor of Osteopathic Medicine (DO) is fully licensed in medicine with specific training in the manual manipulation of the human musculoskeletal frame.
Are Holistic Doctor Services Covered by Medicare?
Doctors who offer holistic treatments may do so in coordination with traditional medical care for their patients. They may integrate different types of services into your treatment plan. Medicare covers services that are considered medically necessary and may base coverage on specific criteria.
The doctors you choose and the Medicare plan you have may affect your costs and coverage. In general, Original Medicare does not restrict beneficiaries to a provider network. You can see any licensed, qualified healthcare provider across the U.S. who works with Medicare and accepts assignment.
Your out-of-pocket costs can vary depending on what doctor you visit, how often you require care, and where you live. If you visit a doctor who does not accept assignment, you may need to pay all of your costs out-of-pocket.
If you’re enrolled in a Medicare Advantage plan, you may have to visit providers within the plan’s network, but you may have access to benefits outside of Part A and Part B.
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Does Medicare Cover Integrative Medicine?
Holistic medicine holds the promise of reducing the need for pain medication and promoting overall health and wellness. Some people turn to integrative care after a medical diagnosis to find alternative treatments when conventional strategies haven’t worked.
If you’re wondering when is holistic medicine covered by Medicare, the following are three examples of alternative practices that Medicare covers on a limited basis to address specific health conditions.
When Does Medicare Cover Alternative Medicine?
Acupuncture is an ancient practice of piercing specific areas of the body with needles to relieve pain or treat ailments. If you have chronic low back pain, you are eligible for Medicare coverage of up to 12 acupuncture visits within a 90-day period.
The dictionary defines chronic as something that lasts a long time or recurs frequently. From a Medicare perspective, chronic lower back pain is defined as having an unknown cause, lasts at least 12 weeks, and is unrelated to pregnancy or surgery.
Medicare may extend acupuncture benefits to an additional eight sessions if the practitioner reports that you have demonstrated improvement. You are subject to the Part B deductible and 20% coinsurance.
Chiropractic services involve the manipulation of joints to realign the spine and correct specific back problems. Like acupuncture, chiropractic care is viewed as alternative medicine but over the years has gained more acceptance by the insurance industry.
Subluxation is when a bone partially dislocates from a joint. If this happens and it is medically necessary to undergo spinal manipulation to correct the condition, Medicare will cover up to 80% of the Medicare-approved charges after you meet your Part B deductible.
Based on the philosophy that food is medicine, nutrition evaluation and coaching is a key component of functional medicine. Traditional doctors are more at ease prescribing drugs than guiding patients on nutrition and may refer you to a nutrition professional if needed.
You may be eligible for Medicare coverage for medical nutrition therapy and related services if you meet all the following conditions:
- You received a referral from your doctor
- You have diabetes, kidney disease, or you have had a kidney transplant within the last three years
- Nutrition services are delivered by a qualified Registered Dietitian or nutrition specialist
Nutrition therapy is a Part B preventive service. If the service is approved and you use a Medicare-participating provider, Medicare covers the service in full.
Why is Holistic Care Not Covered by Insurance?
The criteria for Medicare coverage is evidence-based medicine that is medically necessary to treat a specific health condition. This criteria excludes alternative approaches like herbal remedies, Reiki, hypnosis, meditation, aromatherapy and music therapy. Massage therapy is not covered as a stand-alone benefit but may be covered as part of medically necessary physical therapy treatments.
Medicare-covered drugs through Part D plans have to be approved by the Federal Drug Administration (FDA). Medical marijuana is a Schedule I drug and not covered by Medicare Part D. However, Part D may cover dronabinol (generic version of Marinol), which is synthetic tetrahydrocannabinol (THC), approved by the FDA to treat specific disease-related health conditions.
TIP: Read our Medicare basics guide to help you get the most out of your benefits and understand all your options.
Accessing Holistic Benefits with Medicare Advantage
Medicare Advantage enrollees enjoy expanded benefits beyond the Original Medicare program. This may include holistic services, fitness programs, over-the-counter products like supplements, and devices to monitor blood pressure.
Medicare Advantage plans manage costs by employing the use of healthcare provider networks. Check your plan’s provider directory for a list of network doctors and facilities. If you go outside of the network, your benefits may be reduced or unavailable, depending on the plan you have.
If you did not sign up for Medicare Advantage during your Initial Enrollment Period, you have another opportunity to sign up during the annual Open Enrollment Period, October 15 to December 7. During the OEP, you can also explore your options and switch to a different MA plan if you’re already enrolled in one.
TIP: Discover 7 reasons why you might want to switch Medicare Advantage plans.
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If you’d like to explore your option in coverage for holistic or traditional care, you can compare Medicare Advantage, Medicare Supplement or Prescription Drug Plans and find a plan that meets your needs.
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