Many Americans using or thinking about using complementary health products or practices may have questions about paying for them. This fact sheet provides a general overview of related topics and suggests sources for additional information.
Spending on Complementary Health Approaches in the United States
According to the 2007 National Health Interview Survey (NHIS), U.S. adults spent an estimated $33.9 billion out-of-pocket on complementary health approaches in the previous 12 months. They spent about two-thirds ($22.0 billion) on self-care costs (i.e., products, classes, and materials), and the remaining one-third ($11.9 billion) on visits to complementary health practitioners. The $33.9 billion represented approximately 1.5 percent of total health care spending but 11.2 percent of total out-of-pocket health care spending in the United States.
Paying for Complementary Health Approaches Out-of-Pocket
People often pay for complementary health services and products themselves—that is, “out-of-pocket.” For example, the 2007 NHIS found that about one-third of uninsured respondents younger than age 65 used complementary health approaches. Also, even if you have health insurance, your plan may not cover some or all complementary products or practices.
Insurance Coverage of Complementary Health Approaches
Insurance coverage of complementary health approaches is complex and confusing—so much so that it’s almost impossible to make any general statements about it. Coverage may vary greatly depending on state laws, regulations, and differences among specific insurance plans. If you would like to use a complementary approach and you’re wondering whether your health insurance will cover it, it’s a good idea to do some investigating. Contacting your health insurance provider is a good way to start.
Questions you may want to ask your insurance provider include the following:
- Is this complementary approach covered for my health condition?
- Does it need to be
- Preauthorized or preapproved?
- Ordered by a prescription?
- Do I need a referral?
- Do I have to see a practitioner in your network to be covered?
- Do I have any 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?
It’s always a good idea to keep records about all contacts you have with your insurance company, including notes on calls and copies of bills, claims, and letters. This will help if a dispute arises about a claim.
If you’re choosing a new health insurance plan, you may want to ask the insurance provider about coverage of complementary health approaches. Some insurance plans cover selected complementary approaches by allowing participants to purchase special “riders”—or supplements—to their standard health insurance plans. Some offer discount programs, in which plan members pay for complementary approaches out-of-pocket but at a discounted rate.
General information on health plans and benefits is available from the U.S. Department of Labor.
Sources of Information on Insurers
Your state insurance department may be able to help you determine which insurance companies cover specific complementary health approaches. Contact information for state and local consumer agencies, including insurance regulators.
Professional associations for complementary health specialties may monitor insurance coverage and reimbursement in their field. You can ask a reference librarian for help or search for them on the Internet. The National Library of Medicine’s Directory of Health Organizations is a database that contains information about a variety of health organizations and associations.
Asking Complementary Health Practitioners About Payment
If you are planning to use a complementary approach provided by a practitioner, it is important to understand about payment. Here are some questions to ask the practitioner:
- Costs: What does the first appointment cost? What do followup appointments cost? How many appointments am I likely to need? Are there any additional costs (e.g., tests, equipment, supplements)?
- Insurance: Do you accept my insurance plan? What has been your experience with my plan’s coverage for people with my condition? Do I file the claims, or do you take care of that?
Two kinds of tax-exempt accounts help people save money for health expenses and may help you cover the costs of some complementary health approaches. The flexible spending arrangement is a benefit offered by some employers; it allows you to set aside pretax dollars (generally, each pay period) for health-related expenses. The health savings account is for people who participate in high-deductible health plans; you, not an employer, establish this kind of account. For more information, see Internal Revenue Service (IRS) Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (1.2MB PDF).
Federal Health Benefit Programs
The Federal Government helps with at least some health expenses of people who are eligible for Federal health benefit programs, such as programs for veterans, people aged 65 and older (Medicare), and people who cannot afford health care (Medicaid, funded jointly with the states).
Information on health benefits for veterans is available from the U.S. Department of Veterans Affairs. Information on Medicare and Medicaid is available from the Centers for Medicare & Medicaid Services. Two other Internet resources—Benefits.gov and USA.gov)—explain Federal health benefit programs. Benefits.gov has a test you can take about qualifying for programs. The Medicare program has a handbook that explains what services Medicare covers. It is available at www.medicare.gov/Publications/Pubs/pdf/10050.pdf (4.7MB PDF).
The National Center for Complementary and Integrative Health (NCCIH) funds research that helps to build the evidence base used to make decisions about whether complementary health approaches are safe and effective. You can find out about NCCIH-sponsored research and about NCCIH-sponsored clinical trials (studies in people).
NCCIH, like other components of the National Institutes of Health (NIH), is a medical research agency. NCCIH does not provide financial assistance to individuals who are seeking health care. For resources on financial assistance for medical care, visit Financial Assistance Information (NHGRI).
For More Information
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.