United States – Complementary and Alternative Medicine

What types of complementary and alternative medicine are available in the United States?

The phrase “complementary and alternative medicine” — commonly abbreviated to CAM — covers a vast spectrum of health practices, products, and therapies that sit outside the boundaries of conventional or allopathic medicine. When it comes to the sheer variety of CAM options on offer, the United States is arguably unmatched anywhere in the world, a reflection of the country’s rich cultural tapestry and the strong consumer appetite for holistic approaches to health and wellbeing.

Among the most widely used CAM approaches in the United States are relaxation techniques, herbal products, chiropractic treatment, and massage therapy. With roughly 38% of adults and 12% of children incorporating some form of CAM into their lives, these practices have become a standard part of everyday healthcare for vast numbers of people.

CAM can be grouped into five broad categories: alternative medical systems, which include traditional Chinese medicine, naturopathic medicine, Ayurvedic medicine, and homeopathy; biologically-based therapies, which encompass herbal and special dietary treatments; energy therapies such as Reiki, therapeutic touch, magnet therapy, and Qi Gong; manipulative and body-based systems including chiropractic, osteopathy, and massage; and mind-body interventions such as meditation, biofeedback, hypnotherapy, and the relaxation response.

Of all body-based therapies, chiropractic is the most widely recognised, with licensed chiropractors practising in every one of the 50 U.S. states. The hallmark of chiropractic care is spinal manipulation — sometimes called spinal adjustment — which aims to correct abnormalities in the spinal joints. Chiropractic commands a far more prominent role in American healthcare than it does in many other countries, where it may be considerably harder to access or simply less culturally embedded.

Herbal therapy holds the distinction of being the single most popular alternative therapy in the country. While some forms of CAM — such as traditional Chinese medicine and Ayurvedic medicine — have roots stretching back thousands of years, others, such as electrotherapy, are comparatively recent arrivals. Both TCM and Ayurveda are readily accessible, especially in large metropolitan areas that are home to substantial communities with ancestral ties to the regions where these healing systems originated.

A 2022 poll carried out by the National Center for Complementary and Integrative Health found that Americans have meaningfully expanded their use of complementary health treatments over the past two decades, particularly for managing pain. Yoga stands out as one therapy that has experienced especially rapid growth in popularity among adults seeking relief from chronic discomfort.

Massage therapy is another widely embraced body-based modality. Energy therapies operate on the principle that measurable or postulated energy fields — both within the human body and externally — can be harnessed to support healing. Practices in this domain include Qi Gong, Reiki, and therapeutic touch.

Compared with countries such as France or Germany, where homeopathy has historically enjoyed greater institutional standing and has sometimes been covered under national health schemes, homeopathy in the United States occupies a more peripheral role — though products are readily available without a prescription at pharmacies and health stores nationwide. Naturopathy, on the other hand, is in some respects more formally established in parts of the U.S. than in many comparable countries; in certain states, licensed naturopathic doctors hold prescribing authority that would be unusual for such practitioners elsewhere.

Is complementary and alternative medicine regulated in the United States?

The regulatory environment governing CAM in the U.S. is both decentralised and intricate. Unlike countries such as the UK — where national statutory bodies such as the General Chiropractic Council or the Complementary and Natural Healthcare Council provide uniform oversight — the United States entrusts most practitioner regulation to individual states, with federal authority over practitioners themselves remaining comparatively modest.

It is state law, not federal law, that governs the bulk of CAM practice. The federal government does, however, play a substantial role in overseeing dietary supplements. The U.S. Food and Drug Administration (FDA) holds authority over foods, drugs, and cosmetics sold in interstate commerce.

At the federal level, responsibility for regulating complementary and alternative medicines is shared primarily among the FDA, the Federal Trade Commission (FTC), and various state regulatory bodies. The FDA’s remit covers dietary supplements, herbal products, and homeopathic remedies, with a focus on safety, efficacy, and accurate labelling. The FTC, meanwhile, polices the advertising claims of both CAM practitioners and the manufacturers of related products, working to prevent consumers from being misled by false or exaggerated assertions.

The 1994 passage of the Dietary Supplement Health and Education Act (DSHEA) was a landmark moment: by classifying dietary supplements as foods rather than drugs, it significantly curtailed the FDA’s ability to scrutinise their efficacy, safety, or marketing claims with the same rigour applied to pharmaceutical products. Despite a widespread consumer assumption that “natural” equates to “safe,” dietary supplements can carry real risks — including adverse interactions with medications, toxicity at high doses, contamination, and other hazards.

State law shapes CAM practice through mechanisms including professional licensure requirements, defined scopes of practice, and malpractice liability rules. Medical licensing statutes in each state prohibit the unlicensed practice of medicine, which in turn renders it unlawful for unregistered CAM providers to offer certain health services to the public.

Chiropractic, acupuncture, and massage therapy hold licensed status in the majority of states, whereas naturopathy and homeopathy are licensed in far fewer. Some CAM disciplines — chiropractic being the prime example — are licensed across all or nearly all states, even if the precise training, examination, and continuing education requirements differ from one jurisdiction to the next. Others are formally recognised only in a handful of states or not at all.

The legal rules that apply to CAM providers and their practices are in many instances still developing, and they differ meaningfully from state to state; how they apply in practice will depend on the specific clinical circumstances involved. Expats are strongly advised to look into the particular rules of the state where they reside. The National Center for Complementary and Integrative Health (NCCIH) and the U.S. Food and Drug Administration (FDA) both publish current guidance on regulated products and practices.

Section 2706 of the Affordable Care Act contains a non-discrimination provision that bars health insurers from discriminating against any licensed healthcare provider acting within the scope of their state-issued licence or certification. The ACA additionally calls for CAM practitioners to be included in newly established community-based, interdisciplinary health teams.

Is CAM covered by health insurance or the public healthcare system in the United States?

The United States lacks a universal public health system of the kind found in many other nations. Healthcare is instead delivered through a combination of private insurance, employer-sponsored coverage, and government programmes — principally Medicare, which serves people aged 65 and over or those with qualifying disabilities, and Medicaid, which provides coverage for lower-income individuals. CAM reimbursement under all of these arrangements is restricted and inconsistent.

A large proportion of health insurance plans provide no coverage for CAM therapies whatsoever. Among those that do, chiropractic and acupuncture are the modalities most likely to be included, though plans typically cap both the number of sessions and the frequency of treatment for which they will reimburse.

Only a limited selection of CAM therapies — among them chiropractic care, acupuncture, and certain nutritional interventions — have gained sufficient mainstream medical acceptance to be incorporated into standard health insurance packages. Whether a plan will cover a given therapy generally depends on factors such as whether the treatment was ordered by a medical or osteopathic physician, the licensure status of the CAM provider, and the strength of the research supporting the therapy’s effectiveness.

Drawing on figures cited by independent health agents referencing NCCIH data (as of 2024): approximately 91% of large insurers cover chiropractic care when prescribed, though coverage is commonly limited to between 15 and 25 visits with a $20–$30 copay; about 32% of large insurers include acupuncture, usually capping coverage at around 20 sessions per year; roughly 17% cover massage therapy, typically only when other treatments such as physical therapy and medication have proved insufficient; and just 11% of major insurers extend coverage to homeopathic remedies.

Regarding Medicare specifically (as of 2024): Medicare Part B covers up to 12 acupuncture sessions within a 90-day period for chronic lower back pain, with the possibility of eight additional sessions if the patient demonstrates measurable improvement — bringing the annual maximum to 20 treatments over 12 months. Medicare does not recognise naturopathic doctors as a reimbursable provider category and therefore covers no naturopathic consultations. Massage therapy is also entirely excluded from Medicare coverage.

Insurance coverage for naturopathic medicine is expanding across a growing number of states, gradually improving the affordability of naturopathic care. Individual insurers will determine which specific services fall within scope. Many naturopathic doctors also offer income-based sliding-scale fees or reduced cash-pay rates for patients without coverage.

Always confirm your current coverage directly with your insurer, and consult the NCCIH’s guidance on paying for complementary health approaches for the most up-to-date information, as coverage rules and reimbursement thresholds are subject to change.

How much does complementary and alternative medicine cost in the United States?

The majority of CAM expenditure in the U.S. comes directly from patients’ own pockets. Americans spend $14.7 billion out-of-pocket annually on visits to complementary and integrative health practitioners — including chiropractors, acupuncturists, and massage therapists — and a further $2.7 billion on self-care approaches such as homeopathic medicines and self-help materials. This out-of-pocket spending amounts to 9.2% of all personal healthcare expenditure in the country.

What you pay will depend considerably on the type of therapy, the experience and reputation of the provider, your geographic location (costs tend to run higher in cities such as New York and San Francisco than in rural communities, and vary by region more broadly), and whether your provider is in-network with your health plan. The figures presented below are general estimates only; always confirm current rates directly with practitioners or through relevant professional associations.

CAM has evolved into a substantial industry, surpassing $100 billion in total annual revenue in the early 2020s. The U.S. CAM market was valued at USD 28.65 billion in 2023 and is projected to grow considerably over the next decade. This scale fosters genuine competition among providers, and many community health clinics offer sliding-scale fee structures tied to income. The relevant professional association for your chosen therapy — for instance, the American Chiropractic Association or the American Association of Acupuncture and Oriental Medicine — can offer guidance on reasonable pricing and help you identify more affordable options in your area.

How do I find a qualified CAM practitioner in the United States?

Locating a reputable CAM provider in the U.S. is fairly straightforward for the most established therapies, though it demands considerably more diligence when the modality in question is less tightly regulated. The step-by-step approach below is recommended for expats who are new to navigating the American system.

1. Identify your therapy and check state licensing requirements. Since oversight is determined at the state level, your first task is to confirm whether your intended therapy is subject to licensure in your state of residence. Each state’s Department of Health or Board of Professional Licensing maintains a register of practitioners holding valid licences. The NCCIH’s tips for finding a complementary health practitioner is an excellent first port of call.
2. Consult national professional associations. For chiropractic, the American Chiropractic Association is your primary resource. For acupuncture, both the American Association of Acupuncture and Oriental Medicine and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) maintain searchable directories of qualified practitioners. For naturopathy, the American Association of Naturopathic Physicians (AANP) offers a database of licensed NDs.
3. Verify credentials and licensing. Request the practitioner’s state licence number and check it independently against the records held by the appropriate state licensing board. All 50 states licence chiropractors, and approximately 85% of states provide licensure for at least some other CAM disciplines, including naturopathic physicians, acupuncturists, and massage therapists.
4. Ask your primary care doctor for a referral. Physicians at larger hospitals and integrative medicine centres frequently maintain referral relationships with trusted CAM providers. While some historical friction has existed between CAM and conventional medicine, a clear trend toward greater integration has emerged, with a number of hospitals now housing dedicated CAM clinics within their facilities.
5. Check insurance network status. If you are hoping to receive some reimbursement, verify that the practitioner participates in your insurance network before making an appointment. Choosing an out-of-network provider can lead to substantially higher costs or no coverage at all.
6. Be alert to red flags. Exercise caution with any practitioner who claims to be able to cure serious diseases, actively steers patients away from conventional treatment, or attempts to sell large volumes of proprietary supplement products during a consultation. The FTC’s health and fitness resources offer practical guidance on identifying fraudulent health claims.

If massage therapy is your focus, the American Massage Therapy Association (AMTA) provides a practitioner locator tool. The Academy of Integrative Health and Medicine can also assist in identifying board-certified integrative medicine physicians who work in partnership with CAM practitioners.

Are there traditional or indigenous medicine systems practised in the United States?

The United States is home to a remarkable diversity of traditional and indigenous healing systems. The most historically significant are the healing traditions of Native American and Alaska Native peoples, which encompass hundreds of distinct cultural practices across more than 570 federally recognised tribal nations.

Native American healing traditions are typically grounded in a holistic understanding of health that weaves together physical, spiritual, mental, and communal dimensions of wellbeing. While specific practices differ considerably between nations and regions, they commonly include the use of medicinal plants and herbs, sweat lodge ceremonies, healing rituals, talking circles, and consultation with traditional healers or medicine people. These traditions are deeply intertwined with cultural identity and are generally not commercialised or made available to the broader public outside of Native communities.

The Indian Health Service (IHS) — a federal agency housed within the Department of Health and Human Services — delivers healthcare to eligible American Indian and Alaska Native individuals. Some IHS facilities and Tribal health programmes integrate traditional healing practices alongside Western medicine, in recognition of the central role that cultural and spiritual wellbeing plays in overall health. Further information is available on the Indian Health Service website.

No federal statutory framework specifically licences or recognises traditional Native American healing. These practices largely exist outside the mainstream regulatory structure and are governed primarily by individual tribal sovereignty and cultural protocols rather than by state licensing boards.

Beyond Native American traditions, the U.S. is also home to a wide array of folk and cultural healing practices brought by immigrant communities — among them curanderismo, a traditional healing system rooted in Latino and Hispanic culture; Caribbean folk medicine traditions; and various healing practices of African origin. Imported traditional systems such as traditional Chinese medicine and Ayurveda are widely practised, particularly in cities with sizeable South Asian or East Asian populations. Some TCM and Ayurvedic practitioners hold state licences — for instance, under acupuncture licensing frameworks — allowing them to operate within regulated parameters alongside both conventional medicine and mainstream CAM.

Expats encountering traditional healing practices should approach them with cultural sensitivity and respect, and should always keep their conventional healthcare providers fully informed of any traditional remedies or treatments they may be using.

What should expats know about using CAM alongside conventional medicine in the United States?

Integrative medicine brings together the best of conventional medical care and evidence-supported CAM practices, placing the patient’s values and preferences at the centre of treatment and addressing the full spectrum of their physical, mental, and spiritual health.

The U.S. occupies a leading position globally in the development of integrative medicine. Many of the nation’s most prestigious academic medical institutions — including the Mayo Clinic, Cleveland Clinic, Johns Hopkins, and Memorial Sloan Kettering — have established dedicated integrative medicine departments that coordinate CAM with conventional care. For expats arriving from countries where these two worlds remain largely separate, this represents a meaningful advantage.

As patient interest in CAM has grown, graduates of conventional Western medical schools have found themselves under increasing pressure to develop at least a working familiarity with herbal medicine and acupuncture. U.S. primary care physicians are on the whole more open to discussing CAM than their peers in many other countries — a shift shaped both by changing patient expectations and by the decades of research investment made by the NCCIH.

A number of widely used dietary supplements — including garlic, Ginkgo biloba, ginseng, licorice, grapefruit juice, and certain traditional Chinese medicines — carry a meaningful risk of interacting with pharmaceutical drugs. It is essential to inform your conventional doctor of every supplement, herbal preparation, or CAM treatment you are using, including anything purchased over the counter without a prescription. The NCCIH’s Know the Science resources include evidence-based guidance on herb-drug interactions and the safety profiles of specific therapies.

Dietary supplements are not required to submit clinical efficacy or safety data to the FDA prior to being brought to market, a gap that can expose some consumers to meaningful health risks. When purchasing herbal products or supplements, prioritise items bearing third-party quality certification marks — such as those issued by NSF International, USP (United States Pharmacopeia), or ConsumerLab — which signal that the product has undergone independent testing for purity and label accuracy.

The NCCIH’s mission is to establish, through rigorous scientific inquiry, the usefulness and safety of complementary and integrative health interventions and to clarify their role in improving health outcomes. The NCCIH website is the most authoritative free resource available on this subject and is continuously updated with accessible summaries of research findings on individual therapies.

Expats managing ongoing medical conditions should take particular care not to substitute CAM for prescribed treatments without first consulting their doctor. Unlike some healthcare systems, the U.S. has no standardised national referral pathway linking CAM and conventional medicine — making it the patient’s own responsibility to ensure that all treating practitioners have a complete picture of their health situation.

Frequently asked questions

Do I need to speak fluent English to access CAM practitioners in the United States?

Not necessarily. The United States is an exceptionally multilingual society, and many CAM practitioners — especially those who specialise in traditional Chinese medicine, Ayurveda, or other culturally specific healing traditions — are fluent in languages other than English. In larger cities in particular, it is often possible to find practitioners who speak Spanish, Mandarin, Cantonese, Korean, Hindi, and numerous other languages. Professional associations such as the NCCAOM (for acupuncture) and the AANP (for naturopathy) may include language filters in their online practitioner directories. Community health centres and organisations that serve immigrant populations can also provide referrals to practitioners who speak your language.

Is homeopathy legal in the United States?

Yes, homeopathy is entirely legal in the United States. Homeopathic products are sold without prescription at pharmacies and health food retailers across the country. While the FDA does regulate homeopathic products, it does not require manufacturers to demonstrate efficacy before putting them on sale. A small number of states offer formal licensure for homeopathic practitioners, but the majority do not, meaning there is no nationally consistent licensing standard for those who practise homeopathy professionally. Contact your state’s health department for the most current information on licensing requirements in your jurisdiction.

How do I check a CAM practitioner’s credentials in the United States?

For regulated professions — including chiropractic, acupuncture, massage therapy, and naturopathy — you can confirm a practitioner’s state licence by consulting the licensing board of the state where they practise. Each state’s Department of Health or Office of Professional Regulation maintains a publicly accessible online register. For national certifications, bodies such as the NCCAOM (for acupuncture and Oriental medicine) and the National Board of Chiropractic Examiners (NBCE) also maintain their own practitioner records. Always ask any prospective provider for their licence number and take the time to verify it through the relevant official source before committing to treatment.

Are naturopathic doctors able to prescribe medication in the United States?

In certain states, yes. Licensed naturopathic doctors (NDs) hold prescribing authority over a defined range of medications in a growing list of states, including Oregon, Washington, Arizona, and others that have enacted naturopathic medicine statutes. In states that do not licence NDs, naturopathic practitioners operate under a more restricted scope of practice. As of 2024, approximately 25 states and the District of Columbia licence naturopathic doctors. For a current state-by-state breakdown — which continues to evolve — consult the American Association of Naturopathic Physicians at naturopathic.org.

Is acupuncture widely available outside major cities in the United States?

Acupuncture can be found throughout the United States, not only in large metropolitan areas, though the concentration of practitioners is generally greater in cities and along the coasts. The Veterans Affairs (VA) health system now provides acupuncture at many of its facilities around the country, a development that has meaningfully expanded access in areas that might otherwise be underserved. University towns and communities near military installations frequently have reasonable access as well. In truly remote or rural locations, availability may be more limited. The NCCAOM’s practitioner directory at nccaom.org is the best tool for locating certified acupuncturists near you.

How does the U.S. healthcare culture view CAM — is it widely accepted by doctors?

Opinion among American conventional medical professionals spans a broad spectrum, but the overall trajectory is firmly in the direction of greater openness and integration. Leading academic medical centres are increasingly establishing integrative medicine programmes, and many primary care physicians now routinely ask patients about CAM use as part of a thorough health assessment. The NCCIH’s sustained investment in rigorous research has helped generate a meaningful evidence base for a number of specific therapies, lending them greater credibility in clinical circles. Scepticism persists in some quarters — particularly toward modalities that lack robust clinical data — but expats should feel confident raising their CAM use with their doctor and expect a constructive conversation rather than outright dismissal.

What should I watch out for when buying herbal or dietary supplements in the United States?

The American supplement market is vast and operates with relatively limited regulatory scrutiny. Manufacturers face no requirement to demonstrate a product’s safety or effectiveness before bringing it to market, and issues with mislabelling or contamination do arise. To protect yourself, seek out products that carry independent quality certification — marks from NSF International, USP (United States Pharmacopeia), or ConsumerLab indicate that a product has been tested by a third party for purity and label accuracy. The FDA publishes a database of recalled and flagged supplements at fda.gov/food/dietary-supplements. Be sure to inform both your doctor and your pharmacist of all supplements you are taking, particularly if you are concurrently using prescription medications, given the potential for harmful interactions.

Are there integrative medicine clinics where I can access both conventional and CAM care under one roof?

Yes, and this is one of the genuine strengths of the American healthcare landscape. Many hospitals and health systems — including the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine, Mayo Clinic’s Integrative Medicine and Health programme, and hundreds of smaller regional institutions — provide coordinated care that brings conventional medicine and complementary therapies together in a single setting. The Academic Consortium for Integrative Medicine and Health (imconsortium.org) represents more than 75 academic health centres with active integrative medicine programmes, and their website can help you identify one in your area. Some community health centres and federally qualified health centres also offer CAM services on a sliding-scale fee basis, making integrated care accessible regardless of income.