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The Lowdown

  • Medicare requires a person receives outpatient treatment before seeking a higher level of care
  • You can make a single-case agreement with certain facilities to gain residential and outpatient care
  • You must meet certain eligibility requirements for disorders outside of anorexia nervosa to be covered by Medicare

An eating disorder is a psychological disorder that impacts eating habits in an unhealthy way. There are eating disorder programs that accept Medicare insurance coverage all over the country.

Medicare covers most inpatient treatment services. Fortunately, doctors often recommend inpatient residential treatment for those with eating disorders.

Different health insurances provide different types of coverage amounts.

Learn more about the different eating disorder programs that accept Medicare. But first, make sure you have the coverage you need. Enter your ZIP code and get a free Medicare quote today.

Are there eating disorder programs that accept Medicare?

A variety of eating disorder programs accept Medicare. However, some of the programs have stipulations.

For example, UCLA only accepts patients under the age of 25, and Rogers Memorial requires a case manager to authorize a single case agreement when it’s out of state.

Eating Disorder Treatment Programs
Program Location
Brookhaven Specialty HospitalTulsa, OK
Denver Children's Hospital for Eating DisordersAurora, CO
Eating Disorder InstituteFargo, ND
Johns Hopkins HospitalBaltimore, MD
Lindner Center for HopeMason, OH
River Oaks Hospital Moreland, OK
Rogers MemorialOconomowoc, WI
Rosewood Center for Eating Disorders Wickenburg, AZ
Sheppard Pratt Health SystemBaltimore, MD
UCLA ** only patients under the age of 25Los Angeles, CA
UNC Center of Excellence for Eating DisordersChapel Hill, NC

University of Iowa Eating Disorder ServicesIowa City, Iowa
Waldon Behavioral CareWaltham, MA
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These places, along with your case manager, will help you develop an eating disorder Medicare plan.

Types of Programs That Accept Medicare

If you need to enroll in an eating disorder program that accepts Medicare, you will want to look into residential treatments that accept inpatient coverage.

These types of treatment programs are in a hospital setting and focus on medical stabilization. Although it is provided for a short amount of time, the program is followed up by a residential level of care.

To determine your type of care, contact a Medicare representative and ask to be assigned to a case manager. A case manager will be your advocate as you find care and receive treatment.

Next, you will want to know what facilities are available for residential treatments. A single case agreement can be made with certain facilities to gain residential and outpatient care.

Suppose the treatment center does not allow a single case agreement, and you are under the age of 26. In that case, a parent or guardian can add you to their insurance policy that may cover residential treatment. Most children, however, can’t be on Medicare.

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Medicare Coverage and Benefits for Eating Disorder Programs

Medicare Part B includes services in outpatient clinics or emergency rooms. You may have to pay a health insurance deductible or coinsurance amount unless you have a Medigap plan.

Usually, Medicare requires that a person receive outpatient treatment before seeking a higher level of care. The services covered by Part B include medication therapy, psychotherapy, and patient education.

Preauthorization is needed before any treatment begins.

Medicare covers a variety of treatments for eating disorders, including partial hospitalization programs (PHP).

The hospital’s outpatient department or the community mental health center’s occupational therapy will provide these programs. However, there is a coinsurance payment for each day of PHP services.

Medicare also covers occupational therapy.

What is not covered by Medicare includes meals, transportation, support groups, and mental health testing.

You will be responsible for a percentage of each Medicare-approved service you receive.

Before seeking Medicare insurance coverage, you must document the following:

  • The diagnosis of your eating disorder
  • The diagnosis of any psychiatric disorders
  • The physiological complications of the eating disorder
  • The level of care recommended to you: outpatient, inpatient, partial hospitalization, intensive outpatient
  • The anticipated duration of the recommended treatment

With this information, you will be put on an eating disorder Medicare plan.

What are the eligibility requirements for Medicare to cover an eating disorder?

For eating disorders outside of anorexia nervosa, you must meet the following eligibility requirements for Medicare to cover treatment.

The first requirement is a clinical bulimia nervosa diagnosis, binge-eating disorder diagnosis, or other specified feeding or eating disorder.

Next, you must be assessed with the Eating Disorder Examination Questionnaire (EDE-Q) and receive a score of three or higher.

You must also have at least two of the following:

  • clinically underweight
  • current or high-risk of medical complications due to disorder behavior or symptoms
  • comorbid medical or psychological conditions
  • admitted to hospital for disorder in the last 12 months
  • inadequate treatment response over six months despite active and consistent participation

Finally, you must have your condition characterized by either rapid weight loss, frequent binge eating, or inappropriate compensatory behaviors.

Eating Disorder Medicare Changes

As of July 1, 2021, there have been new eating disorder Medicare changes. Now, General Practitioners (GPs) and other medical practitioners telephone items will be streamlined.

These changes parallel how providers are using these items. It is also based on expert advice regarding the use of telephone-based services.

No changes are in place for face-to-face items or telehealth items delivered via videoconference.

What are eating disorder Medicare item numbers?

Eating disorder Medicare item numbers define services for which Medicare rebates are payable.

They also identify where service providers manage and assess patients diagnosed with anorexia nervosa or other eligible eating disorders.

What can I receive Medicare rebates for?

Eligible patients can receive Medicare rebates for several different services, including:

  • Developing an Eating Disorder Plan (EDP)
  • Reviewing your progress against your EDP after every 10 sessions of psychological treatment
  • To be reviewed by a Psychologist or Pediatrician after 20 sessions of psychological treatment
  • Up to 40 sessions of evidence-based eating disorder psychological therapy per year
  • Up to 20 dietetic services with an accredited practicing dietician per year

You can learn more about Medicare for eating disorders at The National Eating Disorders Collaboration.

Get an eating disorder insurance plan with Medicare today. Enter your ZIP code and get a free quote.