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Insurance Coverage

Kate Farms medical formulas may be eligible for Medicare, Medi-Cal, and most Medicaid & private insurance plans when prescribed for a covered medical need. The Kate Farms Komplete nutrition shake is not coded to be covered by insurance.

Medicare

Medicare covers formula for those who are exclusively tube-fed.

Drinking use

If you are looking for formula to drink and are covered by Medicare, we recommend that you purchase formula on our website.

Tube feeding use

If you or the person you care for are tube fed and covered by Medicare, you can ask your doctor for a prescription for Kate Farms.

Explore our resources covering how to get formula for medical use, or for personalized help, contact a Kate Farms patient advocate.

Medicaid or Medi-Cal

Medicaid and Medi-Cal cover Kate Farms in most states for both tube feeding and drinking.

If you are covered by Medicaid or Medi-Cal and need formula for medical use, we recommend that you explore our resources on how to get formula, or contact a patient advocate to learn more about navigating the insurance process.

Private insurance & other plans

Many private insurance plans cover Kate Farms for people who get at least half of their daily calories by consuming formula.

If at least half of your calories come from formula that you drink—or you are tube fed—we recommend that you read our resources covering how to get formula for medical use, or contact a patient advocate to learn more about navigating the insurance process.

If less than half of your calories come from formula and you are not tube fed, we recommend that you purchase formula on our website.

Checking with your insurance provider

To find out if your policy provides coverage, call the member services phone number listed on the back of your insurance card.

When you call, tell the representative how you will use Kate Farms, either for tube feeding or drinking, and provide the HCPCS code for the Kate Farms formula you want.

  • Kate Farms Standard 1.0 – HCPCS B4150
  • Kate Farms Peptide 1.5 – HCPCS B4153
  • Kate Farms Pediatric Peptide 1.5 – HCPCS B4161
  • Kate Farms Pediatric Standard 1.2 – HCPCS B4160

Questions to ask your insurance provider

Here are a few questions to ask to help you understand your coverage.

Does my policy cover nutrition?

Why this matters: Unfortunately, some insurance policies and companies do not cover nutrition at all. If this is the case, contact our Customer Care team at 805.845.2446, and we may be able to enroll you in our Patient Assistance Program.

What percent of the total prescribed formula cost will my policy cover?

Why this matters: Some insurance policies cover the majority, but not all, of the cost of tube feeding supplies and formula. It’s important to learn what percentage your plan will cover so you are aware of any potential out-of-pocket expenses.

Do I need to show medical necessity?

Why this matters: Your insurance policy will provide guidelines that you must meet in order for them to cover nutrition. Ask your insurance company what those requirements are. In most cases, they will require documentation that proves a medical need for sole-source or supplemental nutrition.

Ask your insurance company what those requirements are. In most cases, they will require documentation that proves a medical need for sole-source or supplemental nutrition in addition to your prescription.

Often, insurance companies require that your doctor write a Letter of Medical Necessity and send it along with your prescription and any relevant clinical notes to the home medical supplier checking your coverage.

Do I need a Letter of Medical Necessity from my doctor?

Why this matters: Often, insurance companies require that your doctor write a Letter of Medical Necessity and send it along with any relevant clinical notes to the home medical supplier checking your coverage. We’ve created Letter of Medical Necessity templates for each Kate Farms formula. Your doctor can use this template to explain your medical need to your insurance company.

Does my policy cover formula for supplemental nutrition?

Why this matters: Some plans only provide coverage when an enteral formula is your only source of nutrition. Ask your insurance company if your policy will provide coverage if less than 100% of your total caloric needs are fulfilled by an enteral formula.

Does my policy cover formula if I’m drinking it?

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

Letters of Medical Necessity

We’ve created Letter of Medical Necessity templates for each Kate Farms formula. Your doctor can use this template to explain your medical need to your insurance company.

Komplete

Kate Farms Komplete is not eligible for insurance coverage. If you have a medical need for formula and need help determining the right one for you, give our Customer Care team a call at 805-845-2446.

Contact Customer Care

We offer personal help to get started on Kate Farms, answer questions, and provide support.