Does Medicare Cover Weight Loss Surgery – Overview
Medicare is one of the most common and biggest health insurance providers in the US. Tens of millions of US citizens are part of the company’s vast insurance coverage.
Very often, we get queries about what types of treatments are covered under the health insurance, such as queries about whether Medicare covers 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 that are covered under the Medicare health insurance program.
What types of Weight Loss Procedures are covered under Medicare?
Medicare offers financial assistance for weight loss procedures only if the procedure has been advised by the physician, such as preparing for bariatric (weight loss) surgery, or as part of your preventive care package.
Let’s take a closer look at the different types of weight loss procedures currently covered by Medicare:
MNT, short for Medical Nutritional Therapy, is mostly used to treat and manage health conditions, such as 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 above-mentioned conditions or have undergone a kidney transplant within the past 36 months. Patients undergoing dialysis are also eligible to receive MNT as part of their standard care plan as it is considered to be preventive. This means that a policyholder will not have to bear any costs of the therapy and procedure. For this, 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, then Medicare will bear the expense of your obesity screenings and behavioral counseling. These preventive services should be offered by your primary care physician or doctor 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, which is a part of original Medicare. You might not have to pay anything out of your pockets as long as you meet the Medicare Part B deductible for the current year.
You don’t get coverage for gym memberships or fitness programs under original Medicare. However, some Medicare Advantage plans provide health and wellness benefits that cover similar services, such as:
- Renew Active – This program is run by UnitedHealthcare 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 is yet another program that offers services across the country, in-person and online.
Before choosing to buy Medicare Advantage Plan, it is strongly recommended to find out 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.
Although Medicare does not offer weight loss surgery coverage exclusively meant for aesthetic improvement, the program will cover the cost of weight loss surgery only if the patient has:
- A BMI of 35 or more
- Had at least one underlying health condition resulting from being overweight
- Previously undergone an unsuccessful medical weight loss procedure
Medicare offers coverage of cost for malabsorptive and restrictive types of weight loss surgeries, including:
- Biliopancreatic diversion with duodenal switch
- Sleeve gastrectomy
- Roux-en-Y bypass
- Adjustable gastric banding
- Vertical 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 as being 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
- Open sleeve gastrectomy
- Laparoscopic vertical banding gastroplasty
- Open vertical banded gastroplasty
If you join any of these non-covered programs, or if you undergo any of these procedures, then you may have to pay for the complete cost of the procedure out of your pocket.
Weight loss procedures are excellent to help you lose unwanted, additional weight. However, original Medicare will not offer coverage for most weight loss procedures unless they are deemed preventive, or if your doctor considers it medically necessary to alleviate your health condition.