In America, many individuals who are 65 and older or have specific disabilities rely on Medicare for assistance in covering their healthcare costs. Medicare covers various healthcare costs, and one area becoming increasingly important is Medical Nutrition Therapy (MNT). In this article, we will explore the coverage aspects of MNT under Medicare, breaking down available coverage, challenges that beneficiaries may face, and tips for maximizing coverage for this specific service.
Medical Nutrition Therapy is provided by a registered dietitian nutritionist and is focused on nutrition-based treatment of conditions such as diabetes and chronic kidney disease.
Medicare beneficiaries can get their Medical Nutrition Therapy covered under Medicare Parts A, B, or C, depending on their plan and the setting in which they receive the services.
Medicare Part B will cover Medical Nutrition Therapy for patients who have diabetes, kidney disease, or have had a kidney transplant during the past 36 months.
Patients receiving dialysis at a dialysis center automatically qualify for Medical Nutrition Therapy coverage under Medicare.
What is Medical Nutrition Therapy?
Medical Nutrition Therapy is provided by a registered dietitian nutritionist and is focused on nutrition-based treatment of conditions such as diabetes and chronic kidney disease. This therapy serves patients by educating them on the nutrition they need to manage their specific conditions and maintain or enhance their overall well-being.
Medicare coverage for Medical Nutrition Therapy
To understand the availability of MNT benefits under Medicare, knowing how Medicare coverage works is essential. Medicare beneficiaries can get their Medical Nutrition Therapy covered under Medicare Parts A, B, or C, depending on their plan and the setting in which they receive the services. Below is a brief breakdown of each Medicare part and how they play into Medical Nutrition Therapy.
Coverage under Medicare Part A
Medicare Part A is focused on providing coverage in inpatient hospital settings. While it doesn’t explicitly cover Medical Nutrition Therapy services, it will cover their costs if required while the patient stays in the hospital.
Coverage under Medicare Part B
Medicare Part B covers outpatient services, including Medical Nutrition Therapy. Beneficiaries can access MNT services on an outpatient basis if they meet the eligibility criteria and are referred by a qualified healthcare professional like a physician or nurse practitioner. They also have to ensure that the Medical Nutrition Therapy services are provided by a professional who accepts Medicare Part B.
Medicare Advantage (Part C) Plans
Medicare Part C is also referred to as Medicare Advantage. Medicare Advantage is a health plan offered by private insurance companies approved by Medicare. These health plans may cover MNT services. Sometimes Medicare Advantage plans provide additional benefits beyond what is provided under original Medicare for Medical Nutrition Therapy, making them a perfect option for those patients who require nutrition therapy regularly.
A note on out-of-pocket costs for MNT
As beneficiaries of Medicare seek to find the required Medical Nutrition Therapy for their needs, they must consider potential out-of-pocket costs, such as copayment or deductibles. Be aware of any deductibles with your health plan because coverage typically kicks in only after the patient’s out-of-pocket expenses are met.
Eligibility criteria for coverage of a Medicare nutritionist
Because Medicare is a government-funded program, they go to great lengths to ensure their resources are used appropriately. Some requirements must be met for your Medicare plan to cover Medical Nutrition Therapy services.
Medicare Part A eligibility
For Medicare Part A to cover Medical Nutrition Therapy, the beneficiary must be admitted as an inpatient to a qualifying hospital or skilled nursing facility. The MNT services provided to the patient must be deemed medically necessary to receive full coverage.
Medicare Part B eligibility
Medicare Part B requires that patients receiving nutrition therapy services meet the following criteria:
- They had a kidney transplant within the last 36 months
- Have a referral from their doctor for the services
- They are diagnosed with diabetes
- They have kidney disease
If patients receive dialysis at a dialysis facility for their kidney disease, they will automatically qualify for this service as part of their care.
Are nutritionists covered by insurance plans like Medicare Advantage?
While Medical Nutrition Therapy is usually not prescribed without a medical need, medicare advantage plans may require specific eligibility criteria to cover these services. Beneficiaries with Medicare Advantage plans should review the terms to understand the requirements or limitations for Medical Nutrition Therapy services.
How to access Medicare nutrition counseling services
Now that you know some of the specific details on how Medicare coverage works for Medical Nutrition Therapy, we want to leave you with some tips on accessing this therapy should you ever require it.
Referral process and requirements
The first step to accessing MNT services under Medicare Part B is to secure a referral from a qualified healthcare professional. Referrals ensure that MNT services are medically necessary and align with the patient’s health plan.
Finding qualified health care professionals
The referral your provider gives you will typically already have a qualified healthcare professional who will provide you with the necessary Medical Nutrition Therapy services. You also have the option to use medicare.gov to search for a registered dietitian nutritionist who accepts Medicare Part B.
Understanding documentation for Medicare plans
Proper documentation of the referral and MNT services are required for Medicare claims. Be sure to communicate with your healthcare provider to ensure all the necessary paperwork is completed so that the claim goes through correctly.
Overall, nutrition counseling services and medical nutrition therapy are benefits under Medicare. However, the level of coverage will vary depending on the type of Medicare plan you have. We recommend reviewing your Medicare plan and the provisions under the policy.
Does Medicare Part A cover Medical Nutrition Therapy?
Medicare Part A will cover medical and nutrition therapy as long as it’s delivered in an inpatient setting and at a hospital that accepts Medicare. Be sure to ask those at the facility providing these services if they take your Medicare Part A plan before agreeing to receive them.
What qualifies as a Medical Nutrition Therapy?
Medical Nutrition Therapy is any service, education, or therapy a registered dietitian nutritionist provides. Typically, a nutritionist will assess their patient's nutritional and health needs, counsel them on their nutrition issues and healthy eating habits, and develop a meal and nutrition plan.
What can a dietician help with?
A dietician can help manage certain health conditions such as diabetes, eating disorders, heart disease, malnutrition, obesity, gastrointestinal diseases, and renal diagnoses. They will help the patient make the most optimal food choices to help them see to their medical needs and overall health.