Medicare is super confusing, and accessing naturopathic care through it has long been difficult. But some recent advances have made it easier to use your coverage to see a naturopathic doctor.
A little background: Since naturopathic doctors are regulated differently by individual states, Medicare as a national program has never recognized us as providers. And I mean “recognize” in the most literal sense: We’ve been completely invisible to them, to the point that they won’t even bother writing a letter denying our claims — which historically has been necessary for accessing secondary insurance plans.
There are now ways to get around that hurdle if folks layer certain additional coverage on top of Medicare.
Secondary insurance: These are usually part of retirement benefits or may be carryovers from prior, non-Medicare plans. If your naturopathic doctor is in network with the company managing this plan, for instance Blue Cross or Aetna, your visits should be covered. We can now skip the step of billing Medicare directly, hearing nothing and getting stuck. This makes your secondary insurance plan more valuable and flexible.
MedAdvantage Plans: These are a little different from secondary insurance, with more limitations about who you can see, how often and at what cost. If your naturopathic doctor is in network with the company managing your MedAdvantage plan, you may be able to see them for a fixed number of visits at a higher copay. Check with the company to see if your naturopathic doctor is on their list of provider specialists. If s/he is, that’s great news!
Unfortunately, the most common additional insurance folks have is the Medicare Supplemental. This extends Medicare coverage, but only for the providers Medicare covers — so naturopathic doctors remain invisible here, even if we’re technically in network with the insurance company managing it. If you have regular Medicare or Medicare Supplemental, you’ll have to pay for naturopathic medical visits out of pocket.
A couple more twists: Any naturopathic doctor, following local laws, can write prescriptions for you that will be covered as usual under your Medicare plan. That privilege is granted under non-discrimination language in the Affordable Care Act. However, lab tests your ND orders will only be covered if the doctor is in network through your secondary or Medicare Advantage plans — and won’t be covered if you’re on Medicare supplemental or Medicare alone.
Medicare is super confusing to everyone involved. The best way to clarify your options generally is to speak with a reputable broker. They’re paid by the insurance companies, not by you, and can be hugely helpful in figuring out the best plan for your specific needs.
If you don’t have insurance coverage for naturopathic care, talk to your provider. I, like many of my colleagues, offer deep discounts for folks who pay directly at time of service. For more information, get in touch or just book your appointment.
Salúd!
—Dr. Orna
Resources:
Explainer about ND Medicare billing from the Oregon Association of Naturopathic Physicians.
Here are a few articles detailing differences between Medicare Advantage and Medicare Supplemental plans:
Learn more about Medicare brokers here.
Header photo by Ravi Patel on Unsplash
