Does Medicare Pay for Ensure?

Does Medicare Pay for Ensure

Dietary supplements like Ensure are often recommended by doctors, but will Medicare help pay for it?

Eating a healthy diet and getting the proper nutrition can help lower your risk for health problems like heart disease, diabetes, osteoporosis, high blood pressure, certain cancers, and obesity. It can also help manage several chronic conditions and prevent complications. When getting the right nutrients, vitamins, and minerals, your body can function at its best.

Unfortunately, eating properly can be difficult due to digestive problems, cognitive impairment, trouble chewing, and other reasons. This is why some older adults turn to nutritional supplements like Ensure to get the proper nutrition.

Ensure has high calorie and high protein content that can quickly replace calories not consumed in other ways. It can also increase protein intake, help with weight gain, and help manage diabetes. While the average price for a six-pack of Ensure shakes is about $10, these costs can add up quickly if you must use them as regular supplements.

Read on to learn about Medicare’s coverage for nutritional supplements, coverage for nutritional assistance programs, and what other options you may have.

Does Medicare cover Ensure?

Ensure is typically considered a nutritional supplement and therefore is not medically necessary, and as with other supplements, it’s not usually covered by Medicare.

The exception to this is if Ensure, or other nutritional supplements, are provided as part of a stay in a skilled nursing facility (SNF) or during an inpatient hospital visit. While this is not common, in these cases, the Ensure would be covered by Medicare Part A.

Because Ensure is not a prescription medication, it’s not covered by Medicare Part D prescription drug plans either.

Each time you purchase Ensure, you’re responsible for the full out-of-pocket cost.

Medicare Advantage coverage for nutritional supplements

Medicare Advantage plans, or Part C, are offered by private insurance companies as another way to receive Medicare benefits. These plans are required to have the at least the same coverage as Medicare Parts A and B, and they usually offer additional benefits like Part D prescription drug coverage, hearing, vision, dental, and more.

Some Medicare Advantage plans may also help pay for nutritional supplements, including Ensure. For example, a plan may offer discounts on purchases, reimbursement for out-of-pocket costs, or partner programs.

Look for a Medicare plan that covers Ensure

Some plans also offer a “wellness card,” which acts as a debit card and provides beneficiaries a certain amount of money each month, quarter, or year. The amount provided and purchases that qualify depends on the plan, but most can be used to purchase OTC medications and products. This may include nutritional supplements and/or Ensure.

Be sure to check with the individual Part C plan to learn more about coverage and costs.

Related reading: How to Compare Medicare Advantage Plans

Does Medigap cover nutritional supplements?

Medicare supplement insurance, or Medigap, helps fill in the “gaps” of Original Medicare by covering things like deductibles, co-insurance, and co-pays. Because Medicare doesn’t generally cover vitamins and supplements, including Ensure, Medigap plans do not cover this either.

Medicare coverage for nutritional assistance programs

While Original Medicare doesn’t cover over-the-counter (OTC) nutritional supplements like Ensure, it does provide a variety of services intended to help you with nutrition and other healthy lifestyle choices. While some of these programs require you to meet certain eligibility criteria, others are available to all Medicare beneficiaries.

Nutrition therapy services

A registered dietician or other nutrition professional who meets certain requirements can provide medical nutrition therapy services. These nutrition counseling services may be covered by Medicare Part B if you have:

  • Diabetes
  • Kidney disease
  • Had a kidney transplant in the last 36 months

If you qualify, you pay nothing for these preventive services, which can include:

  • An initial nutrition and lifestyle assessment
  • Individual and/or group nutritional therapy services
  • Help managing the lifestyle factors that affect your diabetes
  • Follow-up visits to check on your progress in managing your diet

If your dialysis treatments occur at a dialysis facility, Medicare covers nutrition therapy as part of your overall dialysis care. And, if you’re in a rural area, you may be able to get these services via telehealth or other nutritional professional in a different location.

Related reading: Does Medicare Cover Nutritionists?

Diabetes screening

Medicare Part B will cover glucose lab test screenings (with or without a carbohydrate challenge) if your doctor determines you’re at risk for diabetes. You are considered at risk if you have any of these medical conditions:

  • High blood pressure
  • History of abnormal cholesterol and triglyceride levels
  • Obesity
  • History of high blood sugar

Additionally, this screening is covered if two or more of the following conditions apply:

  • You’re 65 or older
  • You’re overweight
  • You have a family history of diabetes
  • You have a history of gestational diabetes or delivery of a baby weighing more than nine pounds

If you meet these criteria, you may be eligible or up to two screenings per year. You pay $0 for these screenings as long as your health care provider accepts assignment.

Obesity behavioral therapy

Obesity behavioral therapy includes an initial screening for body mass index (BMI) and behavioral therapy sessions, including a dietary assessment and counseling, to help you lose weight through diet and exercise.

To qualify for Part B coverage, you must have a BMI of 30 or more. Additionally, your primary care provider must give the counseling in a primary care setting, where they can easily coordinate your prevention plan with your care.

If your provider accepts assignment, you pay $0 for this service.

Yearly wellness visit

As long as you’ve had Medicare Part B for longer than 12 months, you qualify for a yearly “wellness” visit designed to develop or update your personalized plan to help prevent disease and disability. This isn’t a physical exam, but instead is a conversation with your provider that includes:

  • A review of your medical and family history
  • A review of your current providers and prescriptions
  • Taking of height, weight, blood pressure, and other routine measurements
  • Personalized health advice
  • List of risk factors and treatment options
  • Screening schedule for appropriate preventive services
  • Advance care planning

Your provider will also perform a cognitive assessment to look for signs of dementia. Common indicators include trouble remembering, learning new things, concentrating, managing finances, and making everyday decisions.

The Part B deductible does not apply for your yearly wellness visit and you pay $0 if your provider accepts assignment. Note that you may have to pay a co-insurance or Part B deductible if your provider performs additional tests or services during the same visit and if Medicare doesn’t cover those under this preventive benefit. For example, this could include a routine physical exam, which is not considered part of the yearly wellness visit.

Additional resources

DONNA FREDERICK
After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.

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