Enteral Therapy Coverage with Medicare
- Feeding tube therapy provides essential nutrition to individuals who cannot take food orally, and Medicare may help cover feeding tube costs. Find out more.
Tube feeding or enteral nutrition feeding is a therapy in which individuals who cannot eat whole foods or have difficulty swallowing due to illnesses or chronic conditions are provided with essential nutrients in liquid form through flexible tubes.
Feeding tubes are inserted via the nose or through incisions in the stomach so the liquid nutrition can enter the body directly. Feeding tube therapy is performed in both medical and home care settings, with home treatments referred to as home enteral nutrition, or HEN.
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Does Medicare Cover Feeding Tube Therapy?
Under the prosthetic device benefit, feeding tube supplies and equipment are sometimes covered by Medicare Part B. Recipients are typically required to pay 20% of the Medicare-approved amounts after meeting the Medicare Part B deductible.
A Medicare Supplement (also called Medigap) insurance plan can help partially or fully cover your Medicare Part B coinsurance costs for a feeding tube. This can help protect you from potentially high out-of-pocket costs related to your Medicare-covered health services.
Medicare beneficiaries must also receive their enteral infusion pumps through Medicare-enrolled doctors or suppliers to receive proper coverage.
The Medicare Part B prosthetic device benefit provides coverage for prosthetic devices that replace bodily functions or body parts. Feeding tube therapy must be ordered or prescribed by a Medicare-enrolled physician or health care provider.
Factors that may affect the overall costs incurred by Medicare recipients receiving enteral nutrition include the type of facility in which the therapy takes place and whether a physician or health care provider accepts the assignment.
What Are the Two Most Common Types of Feeding Tubes?
The two types of feeding tubes commonly used in medical and home care settings are nasogastric (NG) tubes and percutaneous endoscopic gastrostomy (PEG) tubes.
Nasogastric feeding tubes deliver nutrition directly into the stomach via the nose and throat, and percutaneous endoscopic gastrostomy (PEG) tubes are inserted into the stomach through an incision in the abdominal wall. NG tubes are often prescribed for short-term use, as they can remain in place for up to 2 weeks. PEG tubes are designed for long-term or permanent use.
What Are Some Conditions in Which a Feeding Tube May Be Required?
Feeding tubes are generally recommended for individuals who have trouble eating, drinking or swallowing but have functioning digestive systems. Enteral nutrition may also be prescribed in end-of-life situations to keep people comfortable. Some common conditions that may require tube feeding include:
- Stroke or paralysis that affects the individual's ability to swallow
- Head or neck cancers that affect the throat
- Bowel obstructions or blockages
- Gastrointestinal dysfunction
Are Feeding Tubes Recommended for People With Dementia?
While people with severe dementia sometimes struggle with eating, drinking, and swallowing, feeding tube therapy is generally not recommended, and many caregivers opt for careful hand or spoon-feeding. This is because research has shown that feeding tubes do not benefit those in the later stages of dementia and the tubes may actually cause harm.
A feeding tube inserted via the nose or abdomen may cause unnecessary distress in an individual with Alzheimer's, leading them to try to pull it out and potentially injure themselves. Feeding tubes may also increase the chance of developing aspiration pneumonia or bedsores.
