Medicare was established in 1965 and is a health insurance program for the following:
- people age 65 or older
- people under age 65 with certain disabilities
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare is funded by the Federal Government, does not have financial requirements and coverage is consistent across the nation.
Medicare consists of:
Medicare Part A, also known as Hospital Insurance - Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, hospice and skilled nursing facilities and some home health care.
Medicare Part B, also known as Medical Insurance - Medicare Part B is optional and you must choose to purchase it. Part B helps cover things like doctors' services, outpatient care, some services provided by physical and occupational therapists and some preventive care services like medical nutrition therapy. Medicare Part B provides coverage for enteral nutrition when administered through a feeding tube in the homecare setting or after the first 100 day Part A benefit in a skilled nursing facility. There are medical necessity criteria that must be met and providers like durable medical equipment companies are familiar with the billing and documentation process. Medicare does not provide coverage for nutritional products when orally consumed in the outpatient or homecare setting.
Medicare Advantage, formerly known as Medicare + Choice is a group of Medicare Managed Care Plans offered through commercial insurance companies that are contracted by Medicare. They offer the same benefits provided by traditional Medicare and depending on the plan, may provide extended benefits. Contact your Medicare Managed Care plan for specific coverage policies and guidelines for enteral nutrition.
Medicare Part D, also know as Prescription Drug Coverage - Beneficiaries can choose a drug plan and pay a monthly premium. The Medicare Prescription Drug Plan provides coverage for both brand-name and generic prescription drugs. Enteral nutrition is not covered under Medicare Part D.
NOTE: Information contained in this section is taken from a variety of sources including, but not limited to, official government documents. Such information is provided for our customers from information correct at the time of publication. Abbott Nutrition and Abbott Laboratories assume no responsibility for omissions, errors, or policy changes contained therein. Additionally, the information provided is meant to be a guide for your information only. Each health care provider office is ultimately responsible for verifying codes, coverage, and payment policies used for individual patients to ensure that they are accurate and appropriate for the services and items provided.