What’s the difference between a dietitian and a nutritionist? (And can I use my HSA/FSA?)

Key Points

1. In the US, there’s no set definition for a nutritionist. Instead, a nutritionist may have a range of qualifications, experiences and expertise—or none at all.
2. Dietitians are nutrition experts. They have advanced training and obtain state certifications. So they’re qualified to work in healthcare settings or with patients needing help with medical conditions.
3. If you have a medical condition, you may be able to pay for nutritional counseling with health insurance or HSA/FSA funds.

When you have a health condition, you may try to improve your symptoms through lifestyle modifications. For many people, eliminating specific foods from their daily rotation can make a massive difference in how they feel.

But in your drive for better health, you may also experience unwanted side effects or nutrient depletion. Or you may deprive yourself for no positive gain. Or you may develop disordered eating behaviors, where you’re preoccupied with thoughts about food, ashamed or anxious about your relationship with it, or fall into unhealthy eating patterns.

Luckily, health care professionals like nutritionists and dietitians can provide safe and effective nutrition counseling. And if you have health insurance or a Health Savings Account (HSA) or Flexible Spending Account (FSA), you may be able to get their fees covered!

But which counselor should you seek out—and how can you make sure those costs get covered?

Here, we dig into the details.

What’s the difference between a dietitian and a nutritionist?

In the US, there’s no one definition for a nutritionist. Dietitians, on the other hand, are certified nutrition experts with advanced degrees.

This distinction doesn’t necessarily mean you should always seek out a dietitian versus a nutritionist—especially if you’re healthy and are looking for general meal plan guidance.

But if you have conditions like food allergies or diabetes or need help crafting a Semaglutide diet plan, the details make a difference.

What is a nutritionist?

In many states, anyone can call themselves a nutritionist—even if they have zero training, experience or qualifications.

Some states have licensing requirements. But because they can be hard to find, some health experts worry that patients may receive harmful advice from unqualified sources.

On top of that, not all certifications are created equal! Certifications vary in educational and training requirements.

Some are not trademarked—and so aren’t recognized by states. Some are prerequisites to state certification, while others can’t help students get to that path. Some focus on specific areas of nutrition, while others cover general nutrition advice.

Because of these variables, it can be difficult to determine which qualifications provide nutritionists with the training they need to serve you best.

Here are some nutritionist qualifications to look for:

• Board Certification in Holistic Nutrition (BCHN): Holistic nutritionists offer meal planning, lifestyle improvement and supplementation. To get certified, they must pass a holistic nutrition program, complete 500 experience hours, pass a board exam and maintain continuing education credits.
• Certified Nutritional Consultant (CNC): Members of the American Association of Nutritional Consultants who have a high school diploma or GED and have passed an 11-part test can get this certificate.
• Certified Clinical Nutritionist (CCN): CCNs gain a scientific understanding of physiology + nutrition, so they can do a throughout patient assessment + run point between patients + health providers. On top of having a bachelor’s degree, CCNs have to pass a Clinical Nutrition program exam, complete a 900-hour internship, fulfill continuing education credits and retake their certification exam every five years. In many states, getting this certification can make you eligible to take your state licensing exam.
• Certified Nutrition Specialist (CNS): The most advanced nutritionists have this board certification, which is nationally recognized and makes most people eligible to take their state certification exam. They have a master’s degree in nutrition or a related field, 1,000 supervised experience hours, have passed a board exam and maintain continuing education credits. Because of this, they’re qualified to work in medical settings and provide nutritional guidance for medical conditions.

What is a dietitian?

Dietitians are board-certified nutrition experts with advanced education and training. They’re often referred to as registered dietitians (RDs) or registered dietitian nutritionists (RDNs)—the terms are used interchangeably.

To qualify, a dietitian must:

1. Have a graduate degree from an accredited dietetics program.
2. Have completed 1,000 hours of supervised practice hours in various real-world settings.
3. Have passed the Commission on Dietetic Registration’s national examination for dietitians.
4. Meet their state’s licensing requirements—the LD in their credentials means state-licensed dietitian.
5. Uphold their certification with continuing professional education requirements.

Because of this advanced training, dietitians can advise patients on medical nutrition therapy in healthcare settings (like hospitals, nursing homes and recovery centers), schools and private practice.

Many dietitians specialize in areas of care, like obesity and weight management (CSOWM), diabetes care and education (CDCES), gerontological nutrition (CSG) and sports dietetics (CSSD).

Do I need a dietitian or a nutritionist?

When seeking nutritional counseling, consider your health history, long-term needs, and financial investment. This can help you determine if a dietitian or nutritionist is best for you.

If you’re generally healthy and want to improve your food habits to shed a little weight, improve your workout performance, increase your energy or help you sleep better, you can probably find a licensed nutritionist that meets your needs.

Because countless certification programs exist, you can probably find someone trained to meet your particular interests—like exploring natural foods or helping you with fitness-related nutrition goals. And chances are you’ll only need to meet with them a few times to get personalized guidance.

If you have chronic health issues, take regular medications, need nutrition weight loss coaching or have long-term nutrition goals, a dietitian is more qualified to offer support. They’ll know how nutrition relates to your condition specifically. And chances are your insurance plan will cover at least a portion of the cost.

Will insurance cover a dietitian or nutritionist?

The Affordable Care Act requires insurers to cover nutrition counseling for adults at higher risk for chronic diseases like heart disease, type 2 diabetes, obesity, some cancers and high blood pressure.

Otherwise, rules vary. Some states require insurers to cover at least some of the cost of screening or dietary counseling, and some require insurers to cover diabetes or obesity-related diagnosis and treatment costs. Many insurers also voluntarily cover medical nutritional counseling.

Here’s how to find out if your insurer covers a specific dietitian or nutrition program:

1. Ask your dietitian or certified nutrition specialist for their National Provider Identification (NPI) number. You’ll want that number to confirm whether or not they’re in or out-of-network and generally covered.
2. Call your insurer, and ask if your plan covers Preventative Nutrition Counseling (ICD-10 Code z71.3).
3. Ask if you’ll need a provider referral to guarantee coverage. If so, confirm that your condition is covered and ask for the ICD-10 code. (Conditions include Type 2 diabetes, pre-diabetes, Celiac disease, high cholesterol, food allergies, IBS and hypertension.)
4. Ask if your plan only covers a limited number of nutritional counseling visits. If you want to use telehealth for any of those visits, confirm that those appointments are also included in your coverage.
5. Confirm what out-of-pocket contributions (like your copay or deductible) you’ll have to meet before they cover a portion or all of your first session.

Can I use my HSA/FSA for a nutritionist or dietitian?

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA) and get nutritional counseling to help prevent or treat a medical condition, you can pay for that counseling with your pre-tax funds.

The nutritionist doesn’t need to be a registered dietitian. According to the IRS, as long as the “counseling treats a specific disease diagnosed by a physician,” it qualifies as a medical expense.

The clincher is that nutritionists and dietitians don’t automatically qualify as HSA/FSA-eligible expenses. To get those fees reimbursed from your account, you’ll need a provider to detail how nutrition helps prevent or treat your condition in a Letter of Medical Necessity (LMN). Once you have that letter, you can file it and your receipts to your HSA/FSA administrator for reimbursement.

Can I get nutritional counseling for weight loss covered by HSA/FSA funds?

An in-person or online weight loss coach for nutritional counseling is vital for long-term success.

If you have a condition like high BMI, type 2 diabetes, hypertension, Celiac disease, arthritis or high blood pressure, related nutritional counseling probably qualifies as a medical expense that you can pay for with HSA/FSA funds.

If you take prescription weight loss medications like compounded Semaglutide, Ozempic®* or Wegovy®*, nutritional counseling qualifies.

Shed It—a holistic prescription weight loss program by Dr. B—includes a Letter of Medical Necessity for fitness fees. If you’re already part of Shed It and requested a letter during your intake consultation, it’s available under Documents at your patient dashboard.

To learn more about how Dr. B can help you get Semaglutide online and support your holistic longevity with streamlined nutrition and exercise tools, start an online consultation today!

*Ozempic® and Wegovy® are registered trademarks of their respective owners. Our use of these names is for informational purposes only and does not imply any affiliation, endorsement or approval by the trademark holders.

Sources:

Academy of Nutrition and Dietetics. (2020). What is disordered eating?

Centers for Disease Control and Prevention. Consequences of Obesity.

Healthcare.gov. Preventive care benefits for adults.

Internal Revenue Service. (2024). Frequently asked questions about medical expenses related to nutrition, wellness, and general health.