If you are like 90% of U.S. adults, you do not meet the government’s dietary recommendations for eating enough fruits and vegetables. Low-income people have an especially big challenge in this respect, as they may lack access to healthy Food.
This is important because diet plays an outsize role in health and health costs. About 60% of American adults have at least one chronic disease, and diet-related diseases such as hypertension, diabetes, and lipid disorders are the most common. In fact, diet is now the leading risk factor for death in the U.S. Poor diet is involved in about 500,000 deaths each year.
Until recently, efforts to improve the nutrition of chronically ill people were mostly in the field of public health. Healthcare providers and insurers did very little about this problem. However, now, this may be changing.
The “food as medicine” movement says doctors should use food “prescriptions” as medical treatment. There is no real money behind this approach, and larger investments are expected as emerging research shows that Food as medicine can save money.
Stock Your Kitchen With These Heart-Healthy Foods
Heart-healthy foods can help lower your cholesterol and keep your blood pressure in check. Stock your kitchen with these items.
The biggest sign of this change is a new report showing that in 2024, 1,475 Medicare Advantage plans – about a quarter of the market – will offer eligible enrollees financial help to buy healthy food, mostly fruits and vegetables. In contrast, when the Centers for Medicare and Medicaid Services (CMS) introduced new rules on the supplemental benefits that Medicare Advantage insurers could offer in 2020, only 101 plans showed this benefit.
Meanwhile, the Biden administration has provided waivers to nine states so they can use Medicaid funds to buy Food for chronically sick enrollees. Moreover, a growing number of healthcare systems have joined the food-as-medicine trend. Among them are methods that own health plans, such as Kaiser Permanente and Geisinger, as well as other big techniques like Dignity, Northwell, and Mount Sinai.
Medicare Advantage Plans Take the Lead
The Medicare Advantage plans offer the most solid evidence that the U.S. healthcare industry is starting to take Food as medicine seriously. Most Medicare Advantage insurers lure new members with supplemental benefits such as hearing, vision, and dental services. Since 2019, they have also been allowed to offer additional benefits that are not directly related to medical services.
- RELATED: Benefits of Eating Sweet Potatoes
Initially, CMS allowed the plans to provide “medically tailored meals,” which are healthy meals prepared for people with advanced and costly diet-related conditions such as diabetes, heart failure, end-stage kidney disease, and cancer. Usually delivered to patients at home or in group settings, these meals are designed to nourish people who have been recently discharged from the hospital and, in most cases, are provided for only a few weeks.
Just 336 Medicare Advantage plans will offer medically tailored meals as a supplemental benefit next year, a drop of 27% from 2023. These are far fewer plans than are offering the produce prescription benefit.
Gretchen Jacobson, Ph.D., the vice president of the Medicare program at the Commonwealth Fund, noted that the fruit and vegetable benefit is relatively easy for people to use.
“It usually involves a debit card, so it’s readily accessible to them to use when they go to the store,” she said.
In addition, a produce prescription benefit applies to a much larger group of people than does the medically tailored meals benefit, which is mainly for very sick people, said Dariush Mozaffarian, MD, a cardiologist who is director of the Food Is Medicine Institute at Tufts University.
“Produce prescriptions are used in a less sick population,” he said. “They’re not so sick that they can’t shop and cook. They’re able to buy produce and prepare meals.”
The Medicare Advantage supplemental benefit that became effective in 2020 went beyond medically tailored meals and allowed plans to cover Food and other supports for chronically ill patients, such as transportation, air quality equipment, pest control, and home medications. To qualify for these benefits, a Medicare beneficiary must have one or more serious chronic conditions, have a high risk of hospitalization or other adverse health outcomes, and require intensive care coordination.
Significantly, these criteria do not include food insecurity; a Medicare Advantage plan member does not have to be low-income to qualify. This is true of many Food as medicine programs, noted Mozaffarian.
“It’s not necessarily tied to social needs,” he said. “It’s first and foremost tied to a disease treatment. While some [food as medicine] programs have also focused on social needs such as food insecurity, housing problems, and lower income, not all of them have.”
Why Are Insurers Doing This?
A 2019 Urban Institute paper suggested that Medicare Advantage insurers were not convinced that social determinants of health benefits, including food coverage, could save money. They were also concerned that investing in them might detract from other, more popular uses. So why have they changed their tune on Food being medicine?
Cheap, Healthy Foods
Serving size: 1/2 cup cooked
Cost per serving: Around 20 cents
They are little, but they pack in protein — 9 grams per serving. They are also low in fat, so they can be a healthy, less expensive sub for meat. Plus, they are a good source of folate, iron, and potassium. Moreover, they have plenty of fiber, so they will keep you feeling full longer. Try brown, green, or red lentils as a side dish, in a salad, in stews, or over rice.
Serving size: 1 egg
Cost per serving: About 25 cents
With 6 grams of protein each, the egg is another cheap sub for meat. They are full of nutrients, like vitamins D and A, and choline — essential for pregnant and breastfeeding women. Experts say one egg per day will not throw off your cholesterol numbers. So crack one for breakfast, try one hard-boiled on grain bowls and salads, or scramble some as a base for veggies or in tacos.
Serving size: 1/2 cup (dry)
Cost per serving: About 22 cents
A hot bowl of oatmeal makes a great breakfast. Alternatively, use oats as a healthy filler in meatloaf, burgers, casseroles, and fruit cobblers. Their fiber will keep your stomach satisfied and can lower cholesterol and boost your immune system. They also have antioxidants that may help protect your cells from damage.
Serving Size: 1 medium potato
Cost per serving size: About 15 cents
Sure, they are not as healthy as french fries or slathered in butter and sour cream. However, spuds have vitamin C, fiber, and potassium and may help lower your blood pressure and cholesterol. Slice one and roast it in the oven with a drizzle of olive oil, or top a baked potato with veggies or lean turkey chili for a cheap, easy meal.
Serving size: 1 medium sweet potato
Cost per serving size: About 30 cents
Calories per serving: 103
In just one, you get 400% of your daily vitamin A needs and more than a third of your vitamin C. Sweet potatoes do have more sugar than white ones, but they have fewer calories and carbs and more fiber. Baked or sliced and roasted, they make a great side dish. Alternatively, try mixing shredded ones into muffin batter for added nutrition.
Serving size: About 4 ounces
Cost: About $1.70
Calories: About 155
These little fish are good sources of protein, calcium, vitamin D, and omega-3 fatty acids (EPA and DHA), which help prevent heart disease. For fewer calories, look for those packed in water, not oil. Try them on some whole-grain bread with lettuce and tomato, or chop them with lemon juice and onions to make a fish spread.
Serving size: 1/2 cup cooked
Cost per serving size: 10 cents
Calories: About 112
With about 7 grams of protein per serving, you can substitute beans for meat in many recipes. Moreover, they’ve got plenty of fiber, folate, potassium, and magnesium. To cook dry beans, soak them overnight or boil them for a couple of minutes and let them sit off the heat for an hour before cooking. If you use canned ones, drain and rinse them first to cut down on salt.
Serving size: 2 tablespoons of kernels (3-4 cups popped)
Cost per serving: About 18 cents
Along with the crunch, popcorn packs fiber, which will satisfy you longer than a lot of snack foods. Moreover, it’s a tasty way to get one of the three servings of whole grains you need every day. A cup has less than a quarter of the calories of the same serving of potato chips. Skip the butter and salt, and add flavor with dried herbs.
Serving size: 2 ounces (uncooked)
Cost per serving: 17 cents
Pasta gets a bad rap, but in a reasonable portion, it can be part of an affordable, healthy meal. Plain noodles are low in fat and salt. Whole-grain versions have twice the fiber as white pasta and will raise your blood sugar less. Try spaghetti, penne, or macaroni with a homemade tomato sauce or tossed with olive oil and sauteed veggies.
Serving size: 1 medium-large banana
Cost per serving: 15 cents
This fruit gives you fiber, vitamins B6 and C, and potassium, which balances blood pressure and keeps your heart healthy. It is also easy on your stomach, which makes it a good option when you are getting over tummy troubles. Make one a portable snack, or blend it as a healthy base for smoothies.
Serving size: 2 tablespoons
Cost per serving size: 15 cents
Calories: About 190
Yes, it has a significant quantity of fat. However, it is mostly the healthy, unsaturated kind. It also has potassium and even some fiber. Moreover, it’s not just for sandwiches — try some on celery sticks or apple slices for a satisfying snack.
Serving size: 1/2 cup
Cost per serving: 50 cents
They give you just over 7 grams of protein, a shot of iron, and plenty of fiber. You can put them in salads, cook them in a curry sauce for a spicy entree, or put them in your food processor to make hummus.
Serving size: Around 3 cups uncooked
Cost per serving: 75 cents
Spinach, kale, collards, and turnip greens are low in calories and full of nutrients like folate, iron, fiber, magnesium, calcium, and vitamin C. The pre-washed, bagged kinds are super convenient and still affordable. Use them for a tasty salad, add them to whole-grain pasta, or you can boil, steam, or saute them as a perfect side dish for just about anything.
Serving size: 1/3 cup cooked
Cost per serving: 50 cents
Calories: About 30
You will generally get just as much nutrition from frozen vegetables as you do from fresh, sometimes more. Plus, they stay good longer than fresh produce, so they are less likely to go to waste.
Medically Reviewed by Christine Mikstas, undefined on January 21, 2022
Jacobson said that it is possible that some Medicare Advantage plans view producing prescription benefits as another way to attract and retain enrollees. However, they have to show it improves health, she noted.
David Muhlestein, Ph.D., a visiting policy fellow at the Duke-Margolis Center for Health Policy and formerly chief research and innovation officer at Health Management Associates, agreed with Jacobson that health plans are always looking for ways to distinguish themselves from traditional Medicare, and this might be one way to do it.
Beyond that, he said, “these food programs have shown promising results in some studies, which suggests that they may be a mechanism to reduce the medical cost of care. I think Medicare Advantage plans are hungry for ways to reduce their medical spend via non-medical interventions.”
Two leading insurers, Humana and Elevance, explained why they are providing medically tailored meals and grocery allowances to some of their members.
Humana said it offers its Healthy Options Allowance to eligible members in “chronic condition special needs plans” and to certain Medicare Advantage plan members. The allowance of up to $325 a month helps members pay for “essential living expenses,” including groceries, rent and utilities, and over-the-counter drugs.
According to a Humana spokesman, this program is “designed to provide assistance for certain Medicare Advantage members to address health-related social needs, which can help reduce stress and contribute to an overall healthier life – both mentally and physically.”
Elevance Health plans to “offer both nutritious meals and grocery allowances to many members to help them access healthy food,” an Elevance spokesman said. This includes a “post-discharge meal benefit … our grocery and healthy meal benefits provide [healthy food] access to many of our chronically ill members.”
Both Humana and Elevance focus especially on members who are dually eligible for Medicare and Medicaid. Noting that many of these low-income people live in “food deserts,” the Elevance spokesman said, “providing support to access meals and groceries allows our members to prioritize their health expenses and also alleviates the tough choice many face of going to the doctor or paying for necessities like healthy food.”