Using Health Spending Accounts for Oral Nutrition Supplements

Another tax season has just passed, which is a useful time to review contributions to health spending accounts for the coming year. For one, these funds can cover oral nutrition supplements (ONS) such as Ensure when there is a medical need. ONS are an effective intervention for improving older adults’ nutrition, which is important because one in two older adults is at risk of, or is malnourished.

What Are Health Spending Accounts?

To help cover health expenses, health insurance plans may offer two main types of health spending accounts: Health Spending Accounts (HSAs) and Flexible Spending Accounts (FSAs). Both can help pay for eligible health expenses using pre-tax dollars. Funds in HSAs carry over from year to year and stay with a person if they switch jobs, but only those with high deductible insurance plans can open an HSA. FSAs must be used within the year and are specific to an individual employer-offered insurance plan.

HSAs and FSAs often are used to help pay for items not routinely covered by insurance, but there are restrictions on which specific health purchases qualify. The Internal Revenue Service (IRS) determines eligible items for HSA and FSA reimbursement and employers may have additional limitations. ONS products are generally eligible for HSA and FSA reimbursement when a physician diagnoses a specific medical condition and recommends treatment with ONS products. However, because eligibility requirements can vary by plan, it is important to check with individual HSA/FSA plan administrators to determine necessary criteria and documentation.

Use and benefits of oral nutrition supplements

ONS products are usually high calorie, high protein, flavored ready-to-drink beverages, but also may be available as puddings or powders. These products are fortified with vitamins and minerals and are designed to be consumed orally, rather than used for tube feeding. ONS products are available in stores or can be purchased online.

‘Malnutrition can lead to poor immunity, loss of strength, increased risks of falls and reduced quality of life.’

Physicians may recommend ONS products for individuals with a number of chronic diseases—including cancer, heart disease and respiratory conditions—and there can be important benefits. One study documented use of ONS was associated with more than 38% fewer 30-day hospital readmissions, and the association was stronger for patients with cancer. Some ONS products are specifically formulated for diabetes or kidney disease. Older adults with chewing and swallowing (dysphagia) difficulties may also find ONS products useful. Studies in older adults with dementia found significant improvements in nutrition with ONS products.

People who use ONS products are not able to get enough nutrition from regular food, putting them at risk for malnutrition. Malnutrition can lead to poor immunity, loss of strength, increased risks of falls and reduced quality of life. In addition, malnutrition can worsen chronic conditions and make it difficult for older adults to remain independent. ONS products have been shown to improve daily intake of calories, protein and other recommended nutrients without reduction of food intake and contribute to maintaining and increasing muscle mass. The World Health Organization recommends oral supplemental nutrition with dietary advice for older people affected by undernutrition.

Oral nutrition supplements for surgery

The high protein levels of ONS products are especially helpful for recovery after surgery and some ONS products are uniquely formulated just for this use. The American College of Surgeons found older adults are likely to have poor nutrition or malnutrition prior to surgery, putting them at higher risk of complications after surgery. Studies have long supported pre-surgery nutrition for improved health outcomes and clinicians often implement Enhanced Recovery After Surgery (ERAS) care plans. One study documented delivery of nutrition on the day of surgery in colorectal cancer surgery patients predicted survival after five years.

Good nutrition is a vital part of preventive care for older adults. Many studies confirm the benefits of using ONS products for individuals who are malnourished or at-risk of malnutrition, helping to decrease morbidity and mortality, decrease length of hospital stays, decrease readmission rates, improve quality of life, and decrease healthcare costs. Using healthcare spending accounts where eligible to reimburse for ONS products can help lower potential costs for individuals and support improved health outcomes.

Laura Borth, MS, RD, CD, is the policy associate at Defeat Malnutrition Today in Washington, DC.