Does Medicare Cover Medical Nutrition Therapy?
Last Updated : 09/10/20184 min read
If you are covered under Original Medicare (Part A and Part B) or enrolled in a Medicare Advantage plan, you may be eligible for medical nutrition therapy services at no cost to you if you meet certain requirements. Here’s what you should know.
What is medical nutrition therapy?
According to the National Institutes of Health,
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cancer.gov/publications/dictionaries/cancer-terms?cdrid=482428" target="_blank" rel="noopener">medical nutrition therapy is defined as treatment based on nutrition, and includes checking a person’s nutrition status and giving specific foods or nutrients to treat conditions such as those caused by diabetes. Medical nutrition therapy is overseen by a nutrition professional or registered dietitian.
Medical nutrition therapy may include:
- An initial nutritional and lifestyle assessment
- Nutritional counseling (food selection, meal plans, lifestyle factors, etc.)
- Follow-up visits (to check on your progress)
Who is eligible for medical nutrition therapy under Medicare?
Medicare’s eligibility guidelines for medical nutrition therapy services include the following:
- You must have Medicare Part B coverage, either through Original Medicare or a Medicare Advantage plan.
- You must have diabetes or renal disease (not currently on dialysis), or have had a kidney transplant in the last 36 months.
- Your doctor or health-care provider must recommend medical nutrition therapy services and refer you.
- You must see a registered dietitian or qualified nutrition professional.
You pay nothing for these services (no copayment, coinsurance, or Part B deductible) if your nutrition professional accepts Medicare assignment (please note that Medicare coverage of these services is limited; see below).
What are the limits on the number of medical nutrition therapy services I can receive under Medicare?
Medicare doesn’t limit the number of sessions your doctor can recommend for you; however, it will only cover a limited number of medical nutrition therapy services each year. If your provider recommends that you get more services than Medicare covers, or if he or she recommends nutrition services that Medicare doesn’t cover, you may have to pay some or all of the costs.
Here’s the breakdown of medical nutrition therapy that Medicare covers:
- Three hours of individualized sessions during the first year you become eligible
- Two hours of medical nutrition services per year for each year after that.
Keep in mind that your doctor must continue to recommend these services for you in order for Medicare to cover them. If your diagnosis or health condition changes, you may be eligible for additional services.
In some cases, if you meet medical requirements, you may also be eligible for diabetes self-management training, which often complements medical nutrition therapy for individuals with certain conditions. Diabetes self-management training includes 10 hours of counseling (one individual session and nine group sessions) the first year, with two hours of follow-up training each year if it takes place in a calendar year after the year you received your initial training.
Is there anything else I should know about Medicare and medical nutrition therapy?
It’s important to note that Original Medicare benefits may change each year. If you are enrolled in a Medicare Advantage plan, you may also have access to additional wellness benefits that may work alongside your medical nutrition therapy services. Consult your individual plan booklet or customer service department for more information. While all Medicare Advantage plans must offer the same benefits as Original Medicare (except for hospice care, which is covered under Part A), many include additional benefits such as prescription drug coverage and wellness programs; copayments, annual benefit caps, or coinsurance amounts may apply.
Wondering what benefits, including medical nutrition therapy, are available under Medicare Advantage plan options? I am available to answer your questions. If you’d like an email with information prepared just for you, or would prefer to schedule a phone call at your convenience, click one of the links below. You can also view a list of plans in your area you may qualify for by clicking the Compare Plans button. To find out more about me, click the “View profile” link below.