If a patient has supplemental insurance, what is typical about the 20% Medicare coinsurance for enteral formula?

• A. Supplemental insurance will usually pick up the 20% not covered by Medicare
• B. Medicare pays the 20%
• C. The supplemental insurer covers none of formula costs
• D. The patient pays 100% regardless

Answer: (A)

The key point is how Medicare and supplemental insurance share costs for items covered under Part B. Medicare Part B typically pays about 80% of the approved amount for medically necessary enteral formulas, leaving 20% as coinsurance. Supplemental insurance (like a Medigap plan) is designed to cover those gaps, so most of the time the supplemental policy pays that remaining 20%, reducing or eliminating the patient’s out-of-pocket for the formula. Plan specifics can vary, but the usual arrangement is the secondary insurer covers the coinsurance rather than the patient paying everything or Medicare paying that portion directly.