Does Medicare Cover Weight Loss Surgery?
Last Updated on May 4, 2024 by Kathy
Medicare is the largest and most popular health insurance provider in the United States. The company offers extensive insurance coverage to tens of millions of Americans. But, does Medicare cover weight loss surgery?
In short, while Medicare provides assistance for preventive services to help you maintain a healthy weight, some weight loss services are not covered by Medicare like:
- FDA-approved diet pills or medicines
- Nutrisystem, Weight Watchers, and similar programs
- For weight loss, meal delivery and similar services are available.
Original Medicare, on the other hand, offers assistance for weight loss screenings, nutrition counseling, and more, provided that you meet the criteria. Many Medicare Advantage (Part C), plans offer additional wellness and healthcare services, such as gym memberships or fitness programs.
What types of Weight Loss Procedures are covered under Medicare?
Medicare will only offer financial assistance to weight loss procedures if it has been recommended by a physician. This includes preparing for bariatric surgery (weight loss) or as part of your preventive care package. These are the weight loss procedures that are currently covered by Medicare:
Nutritional Counseling
MNT is shorthand for Medical Nutrition Therapy. It’s used mainly to manage and treat health conditions such as diabetes or kidney problems. In short, this policyholder can be eligible for therapies such as:
- Lifestyle management
- Sessions of nutritional therapy
- Assessment of nutrition and lifestyle
- Follow-up visits
Medicare covers MNT for patients who have had a kidney transplant in the last 36 months or have any of the conditions above. Patients who are undergoing dialysis can also be eligible for MNT, as long as the treatment is preventive. So, the policyholder does not have to pay for the treatment and procedure. Your doctor will refer you to a registered dietitian for counseling.
Obesity Screenings and Counseling
Your Medicare will pay for your behavioral counseling and obesity screenings if your body mass index (BMI) is over 30. These preventive services should only be provided by your primary physician, doctor in a doctor’s office, or primary healthcare center.
Medicare will pay the following:
- Assessment of diet
- Screening for obesity
- Nutrition counseling
Preventive services include obesity screenings and counseling. They are included in Medicare Part B, which is part of Original Medicare. As long as your Medicare Part B deductible is met, you may not need to pay any out of pocket.
Fitness Programs
Original Medicare doesn’t cover gym memberships and fitness programs. However, there are Medicare Advantage plans that offer similar benefits, including:
- UnitedHealthcare offers a Renew Active program that includes gym memberships as well as similar wellness and health programs.
- SilverSneakers is a popular program that helps people 65 and over.
- Silver&Fit – a program that offers services in-person as well as online across the country.
Research the coverage of your state’s Medicare Advantage Plan before purchasing it. For such coverage, you might need to pay an extra premium.
Weight Loss Surgery
Some cases require bariatric surgery to manage extreme obesity. While Medicare doesn’t cover weight loss surgery for aesthetic improvements, it will pay the cost of weight reduction surgery if the patient:
- A BMI greater than 35
- At least one of the underlying conditions that resulted from being overweight was present
- Has underwent medical weight loss surgery (that failed)
Medicare covers the cost of restrictive and malabsorptive weight loss surgery, such as:
- Biliopancreatic diversion and duodenal switch
- Sleeve gastrectomy
- Roux-en-Y bypass
- Gastric banding adjustable
- Vertical gastric banding
If you meet the criteria above, Medicare will pay for weight loss surgery. If you have a Medicare plan, however, you will be responsible for standard Medicare costs if you have:
- Incomplete deductibles
- Payments for specialist visits or doctor visits
- Co-insurance covers all procedures
What does Medicare Not cover under Weight Loss Surgery?
Medicare doesn’t cover the cost of any procedure that are not necessary. So, these are some of the non-covered weight loss procedures:
- Liposuction (only for aesthetic purposes) – if you are a single mom looking for liposuction grants, you can see makeover grants for mommy.
- Bypassing the stomach
- Gastric balloon
- Gastric banding with open adjustment
- Gastrectomy with laparoscopic sleeves
- Open sleeve gastrectomy
- Laparoscopic vertical banding gastroplasty
- Open vertical banded gastroplasty
As a result, you may be responsible for paying the entire cost of any procedure or joining any of these programs.
Medicare Cover Some Weight Loss Surgeries
Weight loss techniques are a great way to lose extra weight. Original Medicare does not cover most weight loss procedures, however, they may reconsider if it’s preventive or necessary to improve your health.
Furthermore, in case you suffers from diabetes, you may consider apply for surgery coverage under Government Diabetes Grants.
