Medicare covers formula for those who are exclusively tube-fed, but unfortunately does not cover formula for drinking.

The best option for someone who will be drinking Kate Farms with Medicare-only (no secondary insurance) is to purchase their formula supply online. Please contact us if you are having trouble affording your formula; we may be able to help.

Medicaid covers Kate Farms in most states for both tube feeding and drinking, whether it’s the primary or secondary insurance plan. To find out which Kate Farms products are eligible for Medicaid coverage in your state, please contact us.

We work closely with Medicaid in all 50 states to ensure coverage is available for those who qualify. If you are having trouble accessing Kate Farms through Medicaid, please contact us. We’d be happy to help.

Medi-Cal is California’s Medicaid program. Most Kate Farms formulas are covered for both tube feeding and drinking through Medi-Cal. CCS is a state program for children up to 21 years of age with certain diseases and health complications. Most Kate Farms formulas are covered for both tube feeding and drinking for CCS beneficiaries who have a CCS-qualifying condition. To find out which Kate Farms products are currently eligible for Medi-Cal and CCS coverage, please contact us.

We work closely with Medi-Cal to ensure coverage is available for those who qualify. If you are having trouble accessing Kate Farms through Medi-Cal or CCS, please contact us. We’d be happy to help.

All Kate Farms formulas are available in Kaiser hospitals and through Kaiser home medical services. Kaiser follows Medicare guidelines, meaning they typically cover medical nutrition for tube feeding, but not for drinking. If you are a Kaiser member, ask your Kaiser healthcare team about writing you a prescription for Kate Farms.

The insurance providers listed above are large companies that offer private insurance plans (often through an employer or purchased on the open marketplace), but some also manage select public insurance plans like Medicare and Medicaid. Because their offerings vary so widely, the best way to determine your plan type and coverage eligibility for formula is to contact them by following the steps on this page, in the How to find out your coverage, section.

Most private insurers do consider coverage for medical nutrition. Coverage eligibility for formula for drinking and tube feeding will vary depending on the type of insurance (e.g., Commercial, Medicare, Medicaid). The best way to determine your plan’s coverage is to contact the insurance company by following the steps below in the How to find out your coverage section.

Why this matters: Unfortunately, some insurance policies and companies do not cover nutrition at all. If this is the case, and you will have difficulty affording our formula, contact us and we may be able to help.

Why this matters: Some plans provide coverage when a formula is your only source of nutrition, or sole-source nutrition, but will not cover if it’s going to be a supplement to solid food. Ask your insurance company if your policy will provide coverage if formula will make up less than 100% of your daily calories.

Why this matters: Some plans cover formula that is used for tube feeding, but not if you are drinking the formula. Medicare is one example of an insurance payor that may cover formula for tube feeding, but not for drinking.

Why this matters: Some health insurance policies cover the majority, but not all, of the cost of tube feeding supplies and formula. For example, they may cover 50% of your formula needs, but you will be responsible for the remaining 50%. It’s important to learn what percentage your plan will cover so you are aware of any potential out-of-pocket expenses.

Why this matters: Prior authorization, also known as a pre-authorization, is a process of obtaining approval for coverage of a prescribed product from your health insurance plan. Enteral nutrition formula oftentimes requires prior authorization to ensure a prescribed product is medically necessary. Your healthcare provider, or in some cases home medical supplier, will complete this process on your behalf. If your insurance requires it, make sure to mention prior authorization to your healthcare provider or medical supply company to remind them of this step.

Why this matters: Your insurance policy will provide guidelines that you must meet for them to cover nutrition. To determine if you meet those guidelines, they may require additional clinical notes and medical documentation to be submitted along with the prescription. Ask your insurance company what those documentation requirements are and let your doctor know. A common requirement is a Letter of Medical Necessity. To make things easier, we have created templates of Letters of Medical Necessity for each Kate Farms formula. Send your doctor the letter for the formula they are prescribing, and ask them to fill it out and send it to your home medical supplier along with the prescription.