48 of 52 Solution Series – Goals – An Apple a Day & More

How many folks do you know who have health and wellness goals at the top of their resolution list for 2022? For as long as I can remember, I have made eating healthier and creating a fitness plan part of my new year’s resolutions. Of course, some years of staying on track were better than others. But for many of our Medicare clients, making nutritional plans and incorporating fitness is essential every day for managing their health conditions. Folks with diabetes and kidney disease can find comfort in the fact that Medicare wants to help manage their conditions too. So there are some dietary programs Medicare will pay for to help you stay on track. 

Medicare also provides coverage for some folks who need support for losing weight. For example, if you have a body mass index (BMI) of 30 or more, Medicare Part B will cover an obesity screening, dietary assessment, and behavioral counseling to help you lose weight by focusing on diet and exercise. You won’t pay anything if your primary care doctor provides your weight management counseling. If you have a Medicare Advantage (Part C) plan, some plans will provide coverage for overall wellness services. But you would need to check with your particular Medicare Advantage plan to confirm if coverage for weight loss plans includes things like meal programs before you sign up for them, to avoid unexpected out-of-pocket expenses.

Nutritional Help For Managing Medical Conditions

Generally, folks with medical conditions requiring special diets consult a registered dietician or other qualified nutrition specialists to create management plans. Original Medicare Part B provides 100% coverage to beneficiaries who qualify, and many Medicare Advantage plans offer coverage for those visits as long as utilizing an in-network provider. Medical Nutritional Help or Medicare MNT is a diet management therapy that Medicare will cover for a defined number of referral-approved visits. The patient will need to meet specific medical criteria which their physician will provide to Medicare to get them qualified for the therapy to be covered.

Medicare has other specific coverage requirements and limitations

• The patient seeking nutritional service coverage by Medicare must have one of the following medical conditions: diabetes, non-dialysis chronic kidney disease, or post kidney transplant (within 36 months of surgery).
• The nutritionist providing the care must have an NPI number and be registered as a Medicare provider.
• Patients need a referral from their primary care physician annually to obtain care from a Medicare MNT nutritionist.
• Medicare limits the duration and frequency of nutritional visits based on a patient’s diagnosis and condition management.

Fitness Programs

Don’t forget about fitness program coverage! Medicare Advantage plans have grown in popularity as a way for folks to incorporate visits to the gym into their wellness goals. Requests for plans with free gym memberships come up regularly in our advisors’ discussions with our clients transitioning to Medicare. Some of those gym memberships even include diet and nutrition education.

Medicare wants your employees to stay healthy. Our advisors can help them find plans to help them maintain their wellness goals when preparing to transition from your group plan. 

Need guidance on how to support your employees with Medicare scenarios and helpful solutions?

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– Lora