Traditional, pharmacologically based medicine has seen a rise in alternatives in recent years. From holistic practitioners to new-age healing, there are plenty of alternatives to prescription medications and surgical procedures. Even plant-based medicines have grown increasingly popular over the last decade. This all leads to a big question involving Medicare.
What is that question? Whether or not Medicare will cover alternative therapies. We will focus on plant-based medicine for the remainder of this post, given that dozens of states have given legal recognition to them. Will Medicare pay for the medicines in those states? In a word, no.
FDA Approval and Legal Status
Medicare has two issues with plant-based medicine. The first is FDA approval. Very rarely does Medicaid agree to cover experimental therapies not approved by the FDA. And given that plant-based medicines do not go through the standard approval process that includes several rounds of clinical testing, they aren’t even on Medicare’s radar.
There are a few exceptions to the rule, mostly involving cases in which an emerging therapy could potentially save a life despite not having yet been approved. But such exceptions are extremely rare.
As for the second issue, legal status, Medicare has not wavered in its unwillingness to cover plant-based medicines that could be illegal under federal law. Even when states recognize such medicines, Medicare does not. Even if Medicare officials wanted to pay for the therapies, they could not do so without being in violation of the Controlled Substances Act.
Clinics Still Claim Medicare Acceptance
The fact that Medicare does not cover plant-based medicines leads to confusion when clinics offering plant-based therapies also advertise that they accept Medicare. This is not intentional – at least in most cases. A clinic offering plant-based medicine can still accept Medicare for other services, as long as it does not bill Medicare for therapies it refuses to cover.
Utah-based KindlyMD illustrates the point extremely well. KindlyMD operates a number of healthcare clinics in the state, clinics that assist with Utah Medical Cards and alternative medicine. But the clinics also offer other services including medication management and mental health therapies. Most of those other services are covered by Medicare.
A patient looking for therapy for PTSD could expect Medicare to cover sessions with the therapist. If the therapist recommended FDA-approved medications, those medications would also be covered. The only things the clinic could not bill Medicare for are plant-based medicines themselves.
The Same Deal With Private Insurance
Patients with private health insurance face the same issues. Generally speaking, insurance companies follow Medicare’s lead in developing policies regarding what they will and will not cover. Because Medicare will not cover plant-based medicines, most private insurance companies will not cover them either. Unfortunately, that means paying for the medicines out of pocket.
Will it ever change? Perhaps. If it does, it will be due to commensurate changes in plant-based medicine’s status under both federal law and FDA approval. No doubt it could happen someday. For now, though, Medicare is off the table for anyone who wants to utilize plant-based medicines.
Patients Should Do Their Homework
A good way to close this post is to remind patients to do their homework. Under our private healthcare system, healthcare providers are still businesses trying to sell services. As such, never assume anything about Medicare coverage or private insurance. It is better to make some phone calls and check the finer details to understand insurance coverage.
Do not expect your insurance or Medicare/Medicaid to cover plant-based medicines and services related to them. Neither insurance companies nor the federal government are on board quite yet.
