Medical Nutrition Therapy: A Free Benefit for Medicare Beneficiaries

Medical nutrition therapy (MNT) is an evidenced-based approach for providing nutrition care aimed at preventing or treating medical conditions and their symptoms.

These services are provided by a registered dietitian nutritionist (RDN) and have been shown to prevent, delay, and manage chronic disease and other health conditions.

Eligible Medicare beneficiaries can receive these nutrition counseling and treatment services at no cost, yet these benefits remain widely underutilized.

This article explains what MNT is, the benefits it provides for preventing and managing disease as well as who is eligible to receive these benefits at no cost.

What is medical nutrition therapy (MNT)?

MNT is an evidenced-based application of the nutrition care process (NCP) provided by an RDN.

The NCP is a systematic approach for providing high quality nutrition care.

The NCP consists of four interrelated steps:

• Assessment: The RDN collects and documents information such as food and nutrition-related history, laboratory data, medical tests, and health history.
• Diagnosis: The data collected from the assessment is used to make an appropriate nutrition diagnosis or problem.
• Intervention: The RDN determines an appropriate nutrition intervention that is aimed at resolving the root cause of the problem or alleviating its signs and symptoms.
• Monitoring and evaluation: The RDN uses specific markers such as body weight or lab values as measures to evaluate whether the person has achieved — or is making progress towards — the predetermined goals.

MNT involves nutrition counseling and treatment. It’s different than nutrition education, which is the reinforcement of basic or essential nutrition-related knowledge that can be provided by an RDN or another qualified health care individual.

Several studies have demonstrated that MNT may not only decrease the risk of developing chronic diseases, such as heart disease, type 2 diabetes, and kidney disease, but in people with these diseases, also reduce their progression (1, 2, 3).

As a result, MNT can decrease healthcare costs by improving health outcomes and lead to improvements in quality of life.

Covered diagnoses for medical nutrition therapy

Eligible Medicare beneficiaries can receive MNT services provided by an RDN who is enrolled as a Medicare provider at no cost when referred by a physician.

MNT is covered under Medicare Part B (medical insurance) and Medicare Advantage plans.

Medicare Advantage — also known as Medicare Part C — is administered by private insurance companies contracted with Medicare.

Medicare covers three hours of MNT the first year and up to two hours of MNT the subsequent years.

MNT services include:

• An initial nutrition and lifestyle assessment
• Nutrition counseling
• Information regarding diet management
• Follow-up sessions to monitor progress

As a Medicare beneficiary, you are eligible to receive these services if you have diabetes, kidney disease, or have had a kidney transplant within the past 36 months (4).

Diabetes

Diabetes is a condition that occurs when your body cannot make or effectively use its own insulin.

Insulin is a hormone produced by your pancreas that lowers blood glucose (sugar) by transporting the sugar into cells for energy.

There are generally two types of diabetes:

• Type 1: The pancreas produces little or no insulin. People with this type must take insulin.
• Type 2: The pancreas may produce insulin, but the body is not responsive to its effects. People may need insulin as the disease progresses or if their blood sugars are unmanaged.

Studies have demonstrated significant improvements in blood glucose control, body weight, waist circumference, cholesterol, and blood pressure in people with diabetes who receive MNT services (3, 5).

These benefits not only reduce the financial burden of diabetes, but they can reduce the risk of health complications associated with uncontrolled diabetes like heart disease and kidney disease (6, 7).

Currently, medicare does not cover MNT for prediabetes.

Chronic kidney disease

Chronic kidney disease (CKD) is the progressive deterioration in kidney function.

Kidney function is assessed using the glomerular filtration rate (GFR).

A GFR of 90 mL/min or higher is considered normal.

There are five stages of CKD (8):

• Stage 1: Kidney damage with normal or increased GFR (>90 mL/min).
• Stage 2: Mild reduction in GFR (60-89 mL/min)
• Stage 3a: Milld to moderate reduction in GFR (45-59 mL/min).
• Stage 3b: Moderate to severe reduction in GFR (30-44 mL/min).
• Stage 4: Severe reduction in GFR (15-29 mL/min).
• Stage 5: Kidney failure (GFR < 15 mL/min).

Research has shown that people with CKD who received MNT were less likely to need dialysis and had improved nutritional status than those who did not receive MNT (9).

If you have end-stage renal failure (ESRD) and are receiving dialysis, MNT is covered as part of your overall dialysis care (4).

The bottom line

Medicare covers MNT if you have a diagnoses of diabetes, kidney disease, or if you have had a kidney transplant within the past 36 months.

MNT services are provided by RDN and have been shown to prevent, delay, and improve the health outcomes of chronic disease.

You can take advantage of these free MNT benefits by requesting a referral from your physician or connecting with an RDN who is enrolled as a Medicare provider can obtain the referral for you.