Does Insurance Cover Nutritionist?

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Created by NutritionED.org Contributor

If you are exploring the career of becoming a nutritionist, you might be wondering if your services would be covered or reimbursed by insurance. The answer to this question varies, depending upon the reason why a client is visiting a nutritionist. Under the Affordable Care Act, nutrition services are available to all adults who are at risk for chronic diseases, in the form of nutritional counseling, with no copayment charged. This is true no matter how the client is insured – through Medicaid, Medicare or private insurance.

Here, we will examine scenarios in which nutritionists are and are not covered by insurance.

Coverage for Nutritionists Under Medicaid

First, let’s examine whether nutritionists are covered under Medicaid.

Medicaid is health coverage provided to certain groups of people who could not otherwise afford it. These groups include low- income adults, children, elderly adults, pregnant women and people with disabilities. Although the program is administered according to federal requirements, its coverage does vary from state to state.

Accordingly, Medicaid coverage for Medical Nutrition Therapy varies from one state to the next, and some states do not recognize Registered Dietitian Nutritionists (RDN) as Medicaid providers. Medicaid must recognize nutrition therapy as optional preventive care services amounting to obesity prevention and treatment under the provisions of the Affordable Care Act, however.

If a client has prediabetes, they might be covered by the National Diabetes Prevention Program (National DPP), a program designed to help Americans prevent or delay Type 2 diabetes. This program may include the services of a nutritionist under Medical Nutrition Therapy. Only certain states cover the National DPP, however. According to the Academy of Nutrition and Dietetics, as of 2018, these states cover the National DPP:

  • Only CA, MN, MT, NJ, NY, TX and VT offer some form of Medicaid coverage for the National DPP
  • MD and OR participated in a Medicaid Demonstration Project to show how the National DPP could work in those states

As rules and regulations surrounding Medicaid are constantly changing, be sure to consult the Medicaid office in your state to find out if nutritionist services are covered and, if so, under what conditions or qualifications.

Coverage for Nutritionists Under Medicare

Medicare is a medical insurance program that covers older adults, usually starting at age 65 but in some cases, as young as age 62.

Unlike Medicaid, Medicare is a federally-run program, meaning that coverage for nutritionists does not vary from one state to the next but, rather, is uniform.

Medicare Part B provides coverage for medical nutrition therapy under certain circumstances and by qualified health care professionals. Clients who have diabetes, kidney disease and kidney transplants that have occurred within the past 36 months qualify for Medicare coverage for Medical Nutrition Therapy (MNT). (Once again, all older adults covered by Medicare qualify for nutritional counseling if they are at risk, under the provisions of the Affordable Care Act).

A client must be referred by a primary care physician to a nutritionist for Medicare coverage to occur. Furthermore, the care must be provided by a Registered Dietitian, Registered Dietitian Nutritionist or any nutritional health care provider who satisfies Medicare’s requirements in that state.

The only types of nutritionists Medicare will cover are:

  • Those who are licensed or certified as a registered dietitian/registered dietitian nutritionist in that state as of December 21, 2000; or
  • After December 21, 2000, the following qualifications must be met:
    • The nutritionist must hold a bachelor’s degree or higher in nutrition and/or dietetics.
    • The nutritionist must have completed 900 hours of supervised dietetics practice.
    • The nutritionist must be licensed or certified as a dietitian or nutrition professional in their state. If that state does not provide licensure or certification, they must be a Registered Dietitian/Registered Dietitian Nutritionist through the Commission on Dietetic Registration (CDR).
  • The nutritionist must be enrolled as a provider in the Medicare program in order to file claims for MNT.

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Coverage for Nutritionists Under Private Health Care Insurance

Coverage for nutritionists varies under private health care insurance.

  • Some policies may cover the services of a nutritionist no matter what.
  • Some may cover their services under certain conditions (i.e., the client has been diagnosed with diabetes).
  • Some insurance plans only cover preventive services offered by a nutritionist, like nutrition counseling.
  • All must cover nutritional services to those at risk for chronic diseases, in the form of nutritional counseling, with no copayment charged, under the Affordable Care Act.

Additionally, if a nutritionist’s services (such as MNT) are covered under a private health care insurance plan, there might be a limit to the number of visits a client may have with a nutritionist, either during a client’s lifetime or in a given year.

Usually, a client must be referred by a primary care provider in order to receive coverage for a nutritionist’s services. A copay must typically be made by the client to the nutritionist for services as well. Finally, most private insurers will require that a nutritionist be registered through the CDR or state licensed/certified in order for their services to be covered or reimbursed.

Liability Insurance for Nutritionists

Another factor to consider if you are contemplating becoming a nutritionist is the need to carry your own liability insurance.

Like all health care professionals, nutritionists must protect their business and services through liability insurance. These policies are available through various insurers and usually include:

  • General Liability: this would come into play in a scenario such as if a client tripped over an object in a nutritionist’s office and broke a bone
  • Professional Liability: this would come into play in a situation such as if a nutritionist advises a client to start a special diet, without asking that client about allergies or medical history, and the client suffers as a result of a bad reaction to that diet
  • Damage to Premises Rented: this would come into play in a situation such as if a nutritionist is counseling a client in rented office space and a fire starts in the office, damaging parts of the office

Some companies that provide nutritionist liability insurance also offer sub-industry insurance, for specializations and other services that nutritionists might offer. These could include:

Members of the Academy of Nutrition and Dietetics can find professional liability services through their referral system.