Generally, Medicare does not cover Ensure; However, Medicare Part A will pay for Ensure and other over-the-counter (OTC) supplements provided during admission at an inpatient hospital or skilled nursing facility. In any other situation, Original Medicare beneficiaries would need to pay for Ensure entirely out-of-pocket.
However, some Medicare Advantage Plans include supplementary OTC benefits that can absorb some or all of the cost of Ensure purchased at local retailers and pharmacies, proving a viable coverage alternative for seniors in need of nutritional assistance.
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What Is Ensure?
Ensure is a nutritional supplement brand that sells bottled “shakes” for seniors. By regularly taking Ensure, adults with digestive problems, missing teeth, cognitive impairment, and other age-related issues can bolster potential holes in their diet and satisfy their daily required allotment of calories and nutrients. For example, older adults with missing teeth could drink Ensure to get valuable minerals usually found in solid foods.
Securing Ensure and other nutritional assistance through Medicare helps many seniors gain weight, increase protein intake, and manage blood sugar levels, preventing chronic conditions like heart disease, diabetes, and obesity, among others.
Limitations on How Original Medicare Covers Ensure
Original Medicare generally only covers medically necessary services, procedures, equipment, and testing. Medicare Part B will never help pay for Ensure or similar OTC vitamins and supplements. Furthermore, while exceptions exist, Part A and Medigap beneficiaries will also encounter significant limitations when trying to access nutritional coverage through Medicare.
Medicare Part A Coverage
Medicare Part A covers items and services received at inpatient hospitals, skilled nursing facilities, and hospice or home healthcare environments. For example, if you spent 10 days in the hospital following an intensive surgery, Part A would pay for your room and board, on-site medications, meals, and most other elements of your stay. If the hospital carried Ensure and provided it during your admission, Part A would likely cover the costs.
Does Medigap Cover Ensure?
Original Medicare beneficiaries can purchase privately-funded Medicare Supplement Insurance, or Medigap plans to help fill Medicare coverage left by deductibles, coinsurance, and copayments. However, because Original Medicare already denies coverage for vitamins and supplements, Medigap does not provide any applicable benefits for Ensure. Even if you receive Ensure through a hospital, Part A would likely cover 100% of the cost, leaving no coinsurance or copayment for your Medigap plan to absorb.
How Does Medicare Advantage Cover Ensure?
Unlike Original Medicare, which receives federal funding and provides relatively uniform coverage, private companies independently structure their Medicare Advantage policies. While these plans must legally offer equivalent coverage to Original Medicare, many include additional benefits like prescription drugs, gym memberships, and nutritional assistance.
For example, some Medicare Advantage policies provide members with preloaded Flex or Wellness for OTC supplies like medications, bandages, and occasionally even Ensure. Meanwhile, Medicare Advantage Special Needs Plans (SNPs) often include grocery coverage that can apply to vitamins, minerals, and supplements. Even so, these allowances typically only reimburse a limited amount of supplies annually.
How Much Does Ensure Cost With Medicare?
Bottles of Ensure cost around $10 for a six-pack. While this may seem affordable, seniors who require two bottles daily to meet their calorie and protein needs can spend up to $600 a year. Therefore, Medicare-eligible seniors who depend on Ensure should consider Medicare Advantage Plans with supplementary nutrition or grocery benefits to help absorb some or all of these costs.
If you have Original Medicare, Part A will pay for 100% of the cost of Ensure provided during your first 60 days of an approved hospital stay. However, Original Medicare will not cover Ensure in any other situation. You must foot the bill entirely out of pocket when purchasing supplements independently.
Medicare Coverage for Nutritional Assistance
While Original Medicare rarely helps pay for Ensure, it does offer the following nutritional assistance benefits:
- Nutritional therapy services: If you have diabetes, kidney disease, or recently received a kidney transplant, Medicare will pay for an initial lifestyle assessment, nutritional therapy services, diabetes counseling, and regular monitoring of dietary adjustments.
- Diabetes screenings: If your doctor determines you are at risk for diabetes due to your weight, high blood pressure, or family history, Medicare Part B will pay for two annual glucose lab test screenings.
- Obesity behavioral therapy: Medicare Part B offers free behavioral therapy sessions, dietary assessments, and fitness counseling to anyone with a BMI of 30 or higher.
- Yearly wellness visit: During these appointments, Part B beneficiaries can have their blood pressure and weight measured, receive personalized health advice, and schedule advance care needs without paying their usual deductible or coinsurance dues.
How to Find a Medicare Advantage Plan That Covers Ensure
Considering the limitations of Original Medicare, seniors who drink Ensure should enroll in Medicare Advantage. Follow these steps to secure an appropriate plan:
- Determine your needs and budget. Medicare Advantage coverage varies by insurer, so look for affordable policies with supplementary nutrition benefits or flex card allowances.
- Compare medical networks. HMOs typically cost less but restrict care to a network of approved medical providers. Meanwhile, PPOs and POS plans allow outside services for slightly increased costs.
- Request quotes. Compare prices from at least three of your top choices to ensure you get the most affordable coverage possible.
- Pay your first premium. After processing your payment, you should quickly receive your new Flex or Wellness card to spend on Ensure and other eligible products.
All in All
Seniors with missing teeth, digestive conditions, and other age-related issues often require vitamins and supplements to help meet their daily calorie, protein, and blood sugar needs. While Original Medicare rarely offers coverage for OTC supplies, some Medicare Advantage beneficiaries can get help paying for Ensure and other dietary aids through Flex cards, nutritional assistance programs, and grocery allowance.
To fully understand your access to Medicare-covered Ensure, call 1-800-MEDICARE or compare applicable health plans online.