A Comparative Analysis Of Medicare And Medicaid In Terms Of Nutritional Services

Medicare and Medicaid are both ran by the government, however they serve different populations. Medicare is a federal program that caters towards patients who are over 65 or disabled; this plan is inclusive of all income levels. Medicaid on the other hand, is a state and federal program that insures people who have low incomes. It is possible to qualify for both Medicare and Medicaid known as dual eligible. Medicare covers some of the basics in obtaining nutritional services. However, additional nutritional services may be required and is not covered by Medicare. This is where private health insurances come to play. Private insurances such as United Health Care cover more extensive nutrition services, which include nutrition counseling, weight loss programs, and nutrition therapy. Medicare part B only covers nutritional services under specific conditions aside to the ones previously mentioned.

What this federal insurance covers is the consultation with the registered dietitian. In addition, the insurance provides a limited coverage only to those who are suffering with diabetes, non-dialysis kidney disease, or has had a kidney transplant within the last 36 months. According to the Academy of Nutrition and Dietetics, 3 hours of medical nutrition therapy of the initial year of referral and up to 2 hours of therapy for subsequent year are covered. Medicare may also cover additional coverage during the second referral of the same year if it’s for a change in diagnosis, medical condition, and treatment regimen. Other services that Medicare might cover include preventative services for cardiovascular diseases. Medicare Advantage also known as Medicare Part C extends coverage in medical nutrition therapy. However, registered dietitians have to have credentials with Medicare Advantage in order to provide nutrition services. Medicaid on the other hand differs from state to state. Each state varies in “type, amount, duration, scope of services, rate of payment for services, and program” according to the Academy of Nutrition and Dietetics. Some challenges for nutritional services under Medicaid include the lack of recognition of registered dietitian nutritionists as approved Medicaid providers. To compare, Medicare covers mandatory benefits whereas Medicaid has the option to comply in covering optional benefits.

According to the Medicaid site, mandatory benefits are services that include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services. In contrast, optional benefits services include prescription drugs, case management, physical therapy, and occupational therapy. Fortunately some states may include coverage for those who are diagnosed with pre-diabetes due to the aid of the National Diabetes Prevention Program (NDPP). NDPP is a program that attempts to prevent or delay type-2 diabetes for those who are at risk. As of 2018, Medicaid covers for the NDPP in Minnesota, Montana and Vermont. California and New Jersey have passed laws to have Medicaid cover the NDPP for 2019. A big well-known private insurance company worth mentioning would be United Health Care. UHC covers more nutrition-related services than Medicaid and Medicare. However, even private insurance companies run into limitations under certain conditions within their coverage. An example for one specifically is enteral and parenteral nutritional therapy. Under this condition, coverage is only accounted for if the patient has a permanent inoperative internal body or function.

According to UHC, medical necessary nutrients, administration supplies, and equipment are only covered if:

• Apatient has a permanent non-functioning disease that prevents food from reaching the small bowel or a disease in the small bowl that affects digestion and absorption from an oral diet, in which requires a feeding tube.
• A patient with a permanent impairment because coverage does not cover temporary impairments of enteral nutrition.
• The condition to be anatomic or due to motility disorders. Gastrointestinal tract impairments are not covered if the cause of the problem is due anorexia, nausea, or mood disordered related.
• The patient must be required to use feeding tubes to maintain weight and strength.

The insurance only covers partial impatient under the conditions of having dysphagia or Crohn’s disease. Enteral nutrition products that are received orally are not insured under this coverage. These conditions are only listed for enteral nutrition therapy. Parenteral nutrition therapy has its own sets of conditions for coverage. So while private insurance companies may offer more services than Medicare and Medicaid, conditions still have to meet the criteria in order for the insurance to cover the expenses. To conclude, after comparing the three different types of insurances, nutritional services are not extensively covered under any of them. There are limits to who or what gets insured under all three insurances.

As of currently, patients who benefit nutritional services under Medicaid or Medicare are patients who are at risk of specific diseases. These insurances cover preventative measures but do not maintain or treat conditions. When diseases or problems do get diagnosed, Medicaid and Medicare offer no coverage for patients regardless of their circumstance. Under private insurances, nutritional services have its limitations in what they can or cannot cover. The coverage is dependent on the scenario of the patient. Patients in this case either have to cover these costs out-of-pocket or apply for a private insurance that covers the specific type of nutritional service needed to maintain their healthcare.