Does Medicare Cover Weight Loss Surgery – Overview
Medicare is a federal health insurance program in the US. Millions of US citizens are part of the company’s vast insurance coverage.
Medicare often receives queries about the types of treatments it covers, including inquiries about weight loss procedures.
Although Medicare does assist with preventive services that help you maintain a healthy weight range, certain weight loss services are exempt from coverage, such as:
- FDA-approved diet medicines or pills
- Nutrisystem, Weight Watchers and similar programs
- Meal delivery and similar services for weight loss
On the other hand, original Medicare offers help for weight loss screenings and nutrition counseling, provided you fulfill the specific criteria.
Besides, several Medicare Advantage (Part C) plans also offer additional wellness and health services, including gym memberships and fitness programs.
To help you, we have listed the number of disorders and their treatments covered under the Medicare health insurance program.
What types of Weight Loss Procedures are covered under Medicare
Medicare covers weight loss procedures like bariatric surgery only if they are medically necessary and prescribed by a physician.
Let’s take a closer look at the different types of weight loss procedures currently covered by Medicare:
Nutritional Counseling
MNT, short for Medical Nutritional Therapy, is mostly used to treat and manage health conditions like kidney problems or diabetes. Under this, the policyholder is eligible to undergo therapies such as:
- Lifestyle management
- Nutritional therapy sessions
- Nutrition and lifestyle assessment
- Follow-up visits
Medicare offers coverage for MNT if you have any of the conditions as mentioned above or have undergone a kidney transplant within the past 36 months.
Patients undergoing dialysis can also receive MNT as part of their standard care plan, as it is considered preventive.
This means that a beneficiary will not have any out-of-pocket costs for the therapy if the Medicare deductible has been met. Your doctor will need to refer you to a registered dietician for counseling.
Obesity Screenings and Counseling
If your body mass index (BMI) is 30 or over, Medicare will pay for your obesity screenings and behavioral counseling. Your primary care physician or doctor should offer these preventive services in a doctor’s office or primary healthcare center.
Medicare will bear the cost of:
- Dietary assessment
- Obesity screening
- Nutrition counseling
Obesity screenings and behavioral counseling come under preventive services and are covered under Medicare Part B, a part of original Medicare.
You might not have to pay anything out of your pocket as long as you meet the Medicare Part B deductible for the current year.
Fitness Programs
Original Medicare does not cover gym memberships or general fitness programs. However, some Medicare Advantage plans provide health and wellness benefits that cover similar services, such as:
- Renew Active – UnitedHealthcare runs this program and offers gym memberships and similar health and wellness programs.
- SilverSneakers – This is one of the most popular fitness programs aimed at helping individuals aged 65 years and over.
- Silver & Fit – This program offers services across the country, in-person and online.
Before choosing to buy a Medicare Advantage Plan, it is strongly recommended to determine the specific coverage offered by the policy within your state. You might have to pay an additional premium for such coverage.
Weight Loss Surgery
There are some cases where bariatric surgery is extremely essential for managing extreme obesity.
Medicare covers weight loss surgery when it is medically necessary, not for aesthetic improvement, and the patient must meet specific criteria such as :
- A BMI of 35 or more
- Had at least one underlying health condition resulting from being obese
Medicare offers coverage of cost for malabsorptive and restrictive types of weight loss surgeries, including:
- Gastric bypass
- Biliopancreatic diversion with duodenal switch
- Sleeve gastrectomy
- Roux-en-Y bypass
- Adjustable gastric banding
Medicare will cover the cost of weight loss surgery if you meet the above-listed criteria. On the other hand, you will end up owing standard Medicare plan costs for the procedure if there are:
- Unpaid deductibles
- Copayments for doctor’s or specialist’s visit
- Co-insurance for any procedures
What does Medicare Not cover under Weight Loss Surgery?
Unless and until the procedure is deemed preventive, Medicare will not offer cover for the cost of that procedure. Some of the weight loss surgeries not covered by Medicare are:
- Liposuction for aesthetic purposes
- Intestinal bypass
- Gastric balloon
- Open adjustable gastric banding
- Laparoscopic sleeve gastrectomy (when medically necessary)
- Open sleeve gastrectomy
If you join any of these non-covered programs or undergo any of these procedures, you may have to pay the full cost of the procedure out of your own pocket.
Conclusion
Weight loss procedures are excellent for helping you lose unwanted, additional weight.
However, original Medicare will not cover most weight loss procedures unless they are deemed preventive or if your doctor considers them medically necessary to alleviate your health condition.
See Also
Does Medicaid Cover Weight Loss Surgery
Follow us