Does Medicare Pay For Feeding Tube Food?

Original Medicare pays for feeding tube food under Part B, specifically the prosthetic device benefit. Medicare beneficiaries are expected to pay 20% of the cost for feeding tube equipment and supplies, including food, after meeting their annual Part B deductible.

A feeding tube can be grouped with other home medical equipment under the Medicare Part B prosthetic device benefit. This part of Medicare pays 80% of the cost for necessary prosthetic and orthopedic devices, along with the accessories and consumables needed to make them function. A feeding tube is usually inserted via the nose or mouth and may be itemized as a home enteral nutrition (HEN) device. Some feeding tubes are surgically inserted directly into the abdomen. As a rule, any device or consumables that are administered during an inpatient hospital stay can be paid for via Part A, which is Medicare’s inpatient benefit, though supplies used after discharge from the hospital are virtually always covered under Part B. Prescription medications delivered via feeding tube are not considered food for insurance purposes, and they are most likely to be covered under Part D, the prescription drug benefit.

Seniors enrolled in Medicare have a choice between Original Medicare and Medicare Advantage, often called Part C. Original Medicare beneficiaries have the traditional coverage options of Parts A, B and D, with feeding tube supplies generally contained in Part B. Medicare Advantage beneficiaries have their Parts A and B coverage grouped together into a single plan, often with an additional prescription benefit, and receive their coverage from a private insurance provider. The terms of these Medicare Advantage plans vary by location and by provider, so it’s always best to check with a plan representative about coverage before receiving medical services. All Medicare Advantage plans are required to provide full Part A and B coverage, however, so the food for a feeding tube is very likely to be included in the basic Part C option, regardless of plan details.

Original Medicare Part B requires beneficiaries to meet their annual deductible amount before their outpatient coverage kicks in. After the initial deductible is met, Part B pays 80% of necessary outpatient expenses. These must be prescribed by a Medicare-approved physician, who deems the feeding tube medically necessary. If you need help covering the annual deductible, or if the 20% share of cost creates hardship for you, you may be eligible for cost reductions or additional coverage. Medigap plans are a supplemental insurance policy seniors can use to cover their unpaid costs for Original Medicare, and seniors with limited resources may be able to use their state’s Medicaid coverage as a supplement at little or no cost. Medigap is not available to Medicare Advantage beneficiaries, though you may still use Medicaid as a supplement if you are still falling short of the uncovered cost.