Medicare & Naturopathy (UPDATED 2025)

Navigating Medicare and naturopathy can be overwhelming. For many, Medicare is a vital source of health insurance once they reach 65, but understanding the different parts—Medicare, Medicare Advantage, Medicare Supplement, and Medicare Part D—can be confusing. It becomes even more convoluted when you try to confirm coverage for naturopathic medicine. Let’s break it all down and explore how each part works to help you make informed healthcare choices.

What is Medicare (Parts A & B)?

Medicare is a federal health insurance program primarily available to people aged 65 and older or to those with certain disabilities. Known as “Original Medicare,” it’s divided into two parts:

• Part A: Covers inpatient hospital stays, hospice, some home health services, and skilled nursing facilities. If you or your spouse worked and paid Medicare taxes, Part A is typically premium-free.
• Part B: Covers outpatient care, doctor visits, preventive services, and medical supplies. Most beneficiaries pay a monthly premium for this part.

Key Points about Original Medicare:

• Government-Run: It’s managed by the federal government.
• Nationwide Acceptance: You can see any doctor or provider who accepts Medicare.
• Out-of-Pocket Costs: Original Medicare includes deductibles, copays, and coinsurance. Many people buy additional insurance, such as Medigap, to cover these expenses.

What is Medicare Advantage (Part C)?

Medicare Advantage, also known as Part C, is an alternative to Original Medicare, provided by private insurance companies. These plans bundle Part A and Part B coverage and may offer additional benefits like vision, dental, hearing, and prescription drugs.

How Medicare Advantage Differs:

• Private Management: It’s run by private insurers, not the government.
• Network-Based Coverage: Plans often require you to use specific providers within a network.
• Extra Benefits: Includes perks like gym memberships or wellness programs, though you may pay more for some benefits.

Types of Medicare Advantage Plans:

• HMO (Health Maintenance Organization): You must use in-network providers except in emergencies.
• PPO (Preferred Provider Organization): Allows out-of-network providers at a higher cost.
• PFFS (Private Fee-for-Service): Providers aren’t in a network, but they must agree to the plan’s payment terms.

What is a Medicare Supplement (Medigap) Plan?

A Medigap plan helps cover some of the out-of-pocket costs not covered by Original Medicare, such as copayments, deductibles, and coinsurance. Medigap policies, offered by private insurers, only work with Original Medicare (not Medicare Advantage).

Key Points about Medigap:

• Not for Medicare Advantage: Medigap cannot be combined with a Medicare Advantage plan.
• Doesn’t Cover Extras: Medigap does not include extra benefits like prescription drugs. For drug coverage, you’ll need a separate Part D plan.
• Eligibility: You must have Medicare Part A and Part B to enroll.

What is Medicare Part D (Prescription Drug Coverage)?

Medicare Part D offers prescription drug coverage and is provided by private insurers approved by Medicare. You can enroll in Part D as a standalone plan alongside Original Medicare or as part of a Medicare Advantage plan that includes drug coverage.

How Part D Works:

• Plan Options: Available as a standalone Prescription Drug Plan (PDP) or bundled with Medicare Advantage (MA-PD).
• Costs: Monthly premiums vary by plan. Additional costs may include deductibles, copays, and coinsurance.
• Formulary: Each Part D plan has a list of covered drugs (formulary), with drugs categorized into tiers that determine cost.

Can You Have a Medicare Supplement Plan with Medicare Advantage?

No, you cannot have both a Medigap plan and Medicare Advantage at the same time. Medigap is designed to work only with Original Medicare to help cover costs that Medicare doesn’t cover.

Can Doctors Bill Medicare Advantage Plans if They Aren’t Contracted with Original Medicare?

Yes, but with some stipulations. Medicare Advantage plans are managed by private insurers and have their own provider networks. Some doctors can contract directly with Medicare Advantage plans without participating in Original Medicare. Here’s how it works:

• Non-Network Billing: Some PPO plans allow billing even if providers are out-of-network, though the patient may pay more.
• Emergency and Urgent Care: Medicare Advantage must cover emergency services regardless of provider network status.
• Private Contracts: Medicare Advantage plans may allow private contracts with providers who are not in the plan’s network, but this varies by plan.

The Big Question: Can Naturopathic Doctors Bill Medicare? What About Medicare Advantage?

The short answer is that, generally, no. Medicare does not cover naturopathic doctors (NDs). Some Medicare Advantage plans have offered limited coverage for naturopathic care in recent years, depending on the state, plan specifics, and provider network. Here’s a closer look at how Medicare coverage for naturopathic services works and what to consider if you’re interested in adding naturopathic care to your health plan.

Traditional Medicare and Naturopathy Coverage

Original Medicare (Parts A & B) does not cover naturopathic services. Naturopathic doctors are typically not recognized as eligible providers under federal law, which excludes them from receiving Medicare reimbursement.

Medicare Advantage (Part C) and Naturopathy Coverage

Medicare Advantage plans are offered by private insurers and provide an alternative to Original Medicare. These plans often include additional benefits, and some have previously included limited coverage for naturopathic services. However, starting in 2024, Regence Medicare Advantage ceased coverage for naturopathic visits. Other Medicare Advantage options are also ceasing coverage. This recent decision has left many patients uncertain, and the change highlights the fluid nature of Medicare Advantage benefits for naturopathic care.

How to Determine if Your Medicare Advantage Plan Covers Naturopathy Services

To find out if your Medicare Advantage plan includes coverage for naturopathic services, here are some steps you can take:

Review Your Summary of Benefits: Medicare Advantage plans send members an annual “Summary of Benefits” that outlines what services are covered.

Contact Your Insurer Directly: The most reliable way to know if naturopathic services are covered is to call your insurer and ask specifically about coverage for naturopathic doctors.

References:

• Centers for Medicare & Medicaid Services. “Medicare.” Medicare.gov.
• “Medicare Advantage.” National Council on Aging, NCOA.org.
• “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.” Medicare.gov.
• “Understanding Medicare Part D.” American Association for Medicare Supplement Insurance, MedicareSupplement.com.
• “Naturopathic Doctor Coverage under Medicare Advantage.” American Association of Naturopathic Physicians, Naturopathic.org.