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Medicare Insurance Coverage For Naturopath Visits

Medicare Insurance Plans Alert!

Medicare does not cover care provided by Naturopathic Physicians. Patients with Original Medicare, even in combination with a Medicare Supplement or “Medigap” policy, receive no benefits when they seek naturopathic treatment and care. Here is where Medicare Part C: Medicare Advanatage Plans come in.

Medicare Part C: Medicare Advantage Plans

Many Medicare beneficiaries take advantage of a different program, Medicare Part C: Medicare Advantage plans. Instead of utilizing Medicare and a Medigap insurance policy, these patients have all their provider services billed to the insurance company with which they have enrolled into their Medicare Advantage plan.

While by law, Advantage plans must be at least actuarially equivalent to Original Medicare, they can also provide additional benefits, such as dental, vision, hearing, transport, and even health club memberships.

Most significant to Naturopathic Physicians, is the fact that some, but though not all, Advantage plans provide some level of benefit for Naturopathic treatment and care.  For patients who are enrolled in such plans, they can typically visit Naturopathic Physicians for only a co-pay.

Timing is critical

Timing is critical. We are currently in the annual Open Enrollment period. Patients have until December 07 to join or change their Advantage plan. Patients can find details of plans in their area at www.medicare.gov/plan-compare. While this is a very comprehensive website, interpreting the details and knowing what to look for is not simple.

Benefits vary greatly by plan and pricing is generally much less than Medigap policies, with some as little as $0/mo premiums.   It is very important that patients seek guidance from a knowledgeable insurance agent in determining which plans suit their individual needs, and how those benefits actually work.

It is also important to know which plans pay equitably to the Naturopathic Doctors. If ND’s don’t accept plans that have poor reimbursements, patients may end up buying a plan which they cannot effectively use, even though it may purport to provide ND benefits. In Oregon , the OANP Board Member Lou Ogden is a 30 year health insurance professional and is available by phone (503-262-8586) and email statewide, as well as in person in the Portland metro area to offer advice and assistance to Medicare eligible beneficiaries when called upon.

Obtaining the right Advantage plan is critical to breaking down barriers to entry for the services of Naturopathic Physicians so  be proactive for the next four weeks of Medicare Advantage Open Enrollment.

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