Your Medicare Coverage
Is my test, item, or service covered?
Enteral nutrition supplies & equipment (feeding pump)
How often is it covered?
Medicare Part B (Medical Insurance) covers enteral nutrition supplies and equipment (feeding pump) under the prosthetic device benefit.
All people with Part B are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount.
Medicare will only cover your enteral infusion pump if your doctor or supplier is enrolled in Medicare. If a supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the pump.
Competitive Bidding Program
If you live in or visit certain areas, Medicare's Competitive Bidding Program may affect you. In most cases, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers when both of these apply:
- You have Original Medicare.
- You get competitively bid equipment and supplies in competitive bidding areas.
Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.
In most cases, you need to obtain your enteral nutrients from a contract supplier for Medicare to help pay. Depending on how long you've been renting your pump, you might not need to get it from a contract supplier.
- If you've been renting an enteral infusion pump on a continuous basis for at least 15 months, your supplier must continue to provide you with the pump as long as it's medically necessary even if the supplier isn't a contract supplier. If your current supplier isn't a contract supplier, it isn't allowed to pick up the pump from you because Medicare is still covering it.
- If you've been renting an enteral infusion pump for less than 15 months, and your current supplier isn't a Medicare contract supplier under the new program, then you'll have to change suppliers. However, your current supplier isn't allowed to pick up any equipment or supplies from you until the last day of the last rental month that began before July 1, 2013. Your current supplier and your Medicare contract supplier must work together and coordinate to make sure you have the equipment you need. For example, if you’ve paid for a rental pump with your current supplier through the end of December, they must continue to provide the equipment you need through December 31 and make sure they work with your new supplier so that you don't have any interruptions in service.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- Whether your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service