Welcome to Fullscript’s integrative medicine education series. Discover how integrative medicine improves patient outcomes and why it’s being adopted by forward-thinking practitioners across North America.
The interest in integrative medicine among patients is growing by leaps and bounds. In fact, according to the National Center for Complementary and Integrative Health (NCCIH), nearly 40% of all adults in the United States use some form of integrative medicine. (1) The good news is that this increased use among patients has led to a significant uptick in the number of medical doctors and osteopathic doctors practicing integrative medicine. (15) With it gaining popularity among practitioners, many ask: is integrative medicine covered by insurance?
The bad news? The health insurance industry hasn’t quite caught up with this trend in integrative healthcare. As a result, many people are left paying for their complementary care out-of-pocket.
The cost of integrative medicine care
While an increasing number of patients are on board with using more complementary medicine (CAM), they often do so at a cost. The NCCIH reports that Americans are paying an estimated $30.2 billion each year for complementary and integrative medicine therapies. That represents 9.2% of all out-of-pocket spending on health care in America. (11) This spending includes:
- $14.7 billion for visits to complementary and integrative medicine doctors
- $12.8 billion for dietary supplements and natural products
- $2.7 billion on self-care like homeopathic remedies and holistic resources (11)
Insurance coverage for alternative and complementary medicine
Many people using integrative medicine often wonder what CAM therapies are covered by insurance. Most people have at least some coverage under their insurance plan but coverage is often restricted to a handful of therapies like acupuncture, chiropractic care, and massage therapy. (6) The problem is, if your policy covers CAM therapy at all, this coverage is often partial. (11) For instance, about 60% of adults who use chiropractic care have policies that only pay for a limited number of visits. Only 25% of those seeking acupuncture and 15% of those in need of massage therapy have any coverage at all. (10)
Among integrative practitioners who are willing to take insurance, one study in the Journal of Alternative and Complementary Medicine reports that the odds of reimbursement are considerably lower than the reimbursements enjoyed by their conventional counterparts. According to the study, reimbursement for acupuncturists was 77% lower than primary allopathic providers. A chiropractor’s reimbursement was about 72% less. And naturopaths received 64% lower reimbursements. (13) As a result, a complementary or integrative medicine practitioner may not take any type of insurance at all. Instead, it’s often up to the patient to make a claim for reimbursement of their out-of-pocket costs.
Did you know? Approximately 87% of insured Americans have at least some coverage for chiropractic care. (9)
Is integrative medicine covered by insurance under your health plan?
Getting insurance to pay for your integrative healthcare can be complicated, especially after you’ve received treatment. One reason for this difficulty is that, even when research clearly shows a benefit, insurance companies can be painfully slow to provide coverage. In one study that appeared in the journal Global Advances in Health and Medicine, researchers cited a paucity of coverage for CAM treatments for chronic low back pain despite recommendations from the American College of Physicians. During their investigation, they found that a holistic approach to chronic pain was not addressed by most state-based health policies. In 46 states, coverage was limited to spinal manipulation (i.e., chiropractic or osteopathic therapy). Acupuncture, biofeedback, and massage were covered in less than 10 states. And mindfulness-based stress reduction, tai chi, and yoga—all therapies shown to benefit those living with chronic pain—weren’t covered at all. (2)(12)(14)(4)
To see if your policy provides integrative medicine or other types of holistic health insurance, it’s wise to read through your policy documents, which can often be found online. You may also choose to call your insurance company to confirm coverage before seeking treatment. The NCCIH recommends keeping detailed records of all verbal and/or written contact you have with your insurance company. (11)
People covered by Medicaid or those over age 65 with Medicare may also have partial coverage for some CAM therapies. For instance, Medicare typically covers a portion of chiropractic care that is deemed medically necessary. (8) According to the government website, if a CAM modality is approved, the patient is required to pay 20% of the approved amount, as well as the Medicare Part B deductible. (5) In 2020, Medicare Part B also started to reimburse charges for acupuncture—but only for those with chronic low back pain. (3) What’s more, you may be eligible for additional CAM benefits if you are on a Medicare Advantage (Medicare Part C) program or have supplemental insurance. (7) As with private insurance, it’s a good idea to document all communication regarding your coverage through any government agency.
Questions to ask your health insurance company
Prior to treatment, consider talking with your health insurance company to make sure it’s covered and that you understand the details of that coverage. The NCCIH suggests asking the following questions:
- Is this integrative approach covered for my health condition?
- Does it need to be pre-authorized or pre-approved?
- Do I need a prescription for this particular therapy?
- Do I need a referral?
- Does coverage require seeing a practitioner in the network?
- Do I have coverage if I go out-of-network?
- Are there any limits and requirements—for example, on the number of visits or the amount you will pay?
- How much do I have to pay out-of-pocket? (11)
Questions to ask your integrative medicine practitioner
The NCCIH also suggests talking with your integrative medicine or CAM provider to ensure they take your insurance and, if so, how much of the cost you are responsible for. Specifically:
- Do you accept my insurance?
- Do I file the claims or does your office take care of that?
- If you don’t take my insurance, what is the cost for the first appointment?
- What do follow-up appointments cost?
- How many appointments am I likely to need?
- Do you anticipate any additional costs for tests, supplements, etc.?
- Is there a sliding scale based on my income? (11)
Tips for increasing your odds of CAM coverage
You may have better odds of coverage if you are seeing a board certified integrative medical doctor or osteopathic doctor. If possible, get your doctor to write a referral or a recommendation for the complementary therapy you want to use. Many insurance companies require that the method be shown to be reasonable and medically necessary, and it may help later on to have a doctor’s recommendation. (16)
Did you know? Your state insurance department might be able to help you find health insurance that covers specific integrative therapies. (11) The National Association of Insurance Commissioners provides an online listing of all state insurance commissioners and their contact information.
The bottom line
Health insurance coverage for integrative medicine is often limited in scope, if a specific therapy is covered at all. Among the many types of CAM therapies, acupuncture, chiropractic care, and therapeutic massage are often the only treatments that are covered. Prior to selecting an integrative medicine doctor or engaging in a specific treatment, it’s wise to check with your insurance company to see if integrative medicine is covered by insurance.
- According to a new government survey, 38 percent of adults and 12 percent of children use complementary and alternative medicine. (2008). National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health. https://www.nih.gov/news-events/news-releases/according-new-government-survey-38-percent-adults-12-percent-children-use-complementary-alternative-medicine
- Bonakdar, R., Palanker, D., & Sweeney, M.M. (2019). Analysis of state insurance coverage for nonpharmacologic treatment of low back pain as recommended by the American College of Physicians Guidelines. Global Advances in Health and Medicine, 8, 2164956119855629.
- Candon, M., Nielsen, A., & Dusek, J.A. (2022). Trends in insurance coverage for acupuncture, 2010-2019. JAMA Network Open, 5(1), e2142509.
- Cherkin, D.C., Sherman, K.J., Balderson, B.H., Cook, A.J., Anderson, M.L., Hawkes, R.J., Hansen, K.E., & Turner, J.A. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. JAMA, 315(12): 1240.
- Chiropractic services. Medicare.gov. https://www.medicare.gov/coverage/chiropractic-services
- Cleary-Guida, M.B., Okvat, H.A., Oz, M.C., & Ting, W. (2001). A regional survey of health insurance coverage for complementary and alternative medicine: current status and future ramifications. Journal of Alternative and Complementary Medicine, 7(3), 269-73.
- Does Medicare cover holistic medicine? Medicare Advantage.com https://www.medicareadvantage.com/coverage/does-medicare-cover-holistic-medicine
- Heyward, J., Jones, C.M., Compton, W.M., Lin, D.H., Losby, J.L., Murimi, I.B., Baldwin, G.T., … Ballreich, Alexander, G.C. (2018). Coverage of nonpharmacologic treatments for low back pain among US public and private insurers. JAMA Network Open, 1(6), e183044.
- Insurance Coverage of Chiropractic: Quick Facts. Massachusetts Chiropractic Society. https://www.masschiro.org/insurance-coverage-of-chiropractic-quick-facts/
- Nahin, R.L., Barnes, P.M., & Stussman, B.J. (2016). Insurance coverage for complementary health approaches among adult users: United States, 2002 and 2012. NCHS Data Brief, 235:1-8.
- Paying for complementary and integrative health approaches. (2016). National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health. https://www.nccih.nih.gov/health/paying-for-complementary-and-integrative-health-approaches
- Qin, J., Zhang, Y., Wu, L., He, Z., Huang, J., Tao, J., & Chen, L. (2019). Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine, 98(37), e17099.
- Whedon, J.M., Bezdjian, S., Goehl, J.M., & Kazal, L.A. (2020). Trends in insurance coverage for complementary health care services. Journal of Alternative and Complementary Medicine, 26(10):966-969.
- Whitehead, P.B. (2018). The effect of yoga on chronic nonspecific low back pain. American Journal of Nursing, 118(2), 64.
- Why integrative medicine now? American Board of Physician Specialties. https://www.abpsus.org/integrative-medicine-now/
- Will my insurance cover complementary and integrative therapies? (2021). American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/complementary-and-integrative-medicine/complementary-and-alternative-methods-and-cancer/insurance-coverage.html