Does Medicare Cover Lap Band Surgery?
Last Updated : 09/10/20183 min read
In some cases, Medicare Part B might cover certain bariatric surgeries, such as lap band surgery.
What is lap band surgery?
Lap band surgery involves placing an inflatable band around the upper area of your stomach, according to the Mayo Clinic.
Saline is then introduced using a port under your skin to tighten the band as needed. Overall, lap band surgery can help you lose weight by restricting the amount of food the stomach can contain. Lap band surgery is also known as laparoscopic adjustable gastric banding.
Lap band surgery: Medicare coverage
Medicare may cover lap band surgery if your Medicare-assigned doctor determines that you meet certain criteria related to obesity. To be covered, you generally must meet all of the following criteria:
- Have a body mass index (BMI) greater than or equal to 35.
- Have at least one co-morbidity related to obesity.
- Have previously received unsuccessful medical treatment for obesity.
Lap band surgery costs
If your doctor recommends lap band surgery for you, you might want to ask about the costs you’ll have to pay. Ask whether you will be an inpatient or an outpatient because that may affect the costs you pay. For example, Medicare Part A might not cover hospital services if you haven’t been admitted as an inpatient.
Even if Medicare covers the procedure, you’ll likely pay some lap band surgery costs such as coinsurance and possible deductible amounts.
How much does lap band surgery cost?
To make sure you understand all the potential costs of this surgery, including copayments, coinsurance, and deductibles:
- If you’re enrolled in a Medicare health plan, such as a Medicare Advantage plan, call the plan.
- If you have Original Medicare, Part A and Part B, you can call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Representatives are available 24 hours a day, seven days a week.
If you have surgery, some private Medicare Supplement (Medigap) plans might cover some out-of-pocket costs not covered under Original Medicare (Part A and Part B) pays, such as copayments and deductibles.
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