Louis Rocco has lived with diabetes for decades, but until he met with a registered dietitian this summer, he didn't know eating too much bread was dangerous for him.
"I'm Italian, and I always eat a lot of bread,” he says. After two hour-long visits with the dietitian — including a session at his local grocery store in Philadelphia — Rocco, 90, has noticed a difference in his health.
"It's helped bring down my sugar readings,” he says of the changes in his diet, including eating less bread. “I wish I knew I could have had this help years ago."
After getting a referral from his doctor, Rocco learned that Medicare also covers personal nutritional counseling for people with diabetes or kidney disease.
The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million people enrolled in private Medicare Advantage plans.
Medicare pays for three hours of dietary counseling during the first year the benefit is used and two hours in subsequent years. A doctor can appeal to Medicare for additional nutritional therapy if the physician believes it is medically necessary.
Congress approved the benefit, which began in 2002, after studies found such counseling leads to improved health outcomes and fewer complications for older patients. Under the Affordable Care Act (ACA), the counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011.
Health experts say the little-used benefit represents a lost opportunity for beneficiaries to improve their health — and for Medicare to save money by preventing costly complications from the diseases.