Does Medicare Cover Weight Loss Surgery?
This article was updated on: 09/12/2018
Weight loss surgery helps people with extreme obesity lose weight, according to the U.S. National Library of Medicine. A person with a body mass index of 30 or higher is considered obese, according to the American Heart Association. More than one-third of U.S. adults are obese. Weight loss surgery may be an option when diet and exercise have failed and your obesity is causing serious health problems, reports the U.S. National Library of Medicine.
How does weight loss surgery work?
Weight loss surgery, also called bariatric surgery, works in two main ways, according to the Mayo Clinic.
- Restriction: weight loss surgery to physically limit the amount of food the stomach can hold
- Malabsorption: weight loss surgery to shorten or bypass part of the small intestine, reducing the amount of calories it can absorb
Four common types of weight loss surgery include:
- Roux-en-Y gastric bypass (weight loss surgery to create small pouch on the top of the stomach to receive food. The small intestine is connected to the new pouch.)
- Laparoscopic adjustable gastric banding (weight loss surgery to create a small stomach pouch above the band with a narrow opening to the rest of the stomach)
- Sleeve gastrectomy (weight loss surgery forming the stomach into a tube-like structure)
- Duodenal switch with biliopancreatic diversion (weight loss surgery to remove a large part of the stomach)
Does Medicare cover weight loss surgery?
Specific types of weight loss surgery may be covered by Original Medicare, Part A and Part B. These are usually covered if your doctor determines the treatment is medically necessary and previous medical treatments have been unsuccessful. In general, weight loss surgery is only approved for Medicare beneficiaries who are considered morbidly obese with a body-mass index ≥ 35 and who have at least one co-morbidity or condition related to obesity, such as type 2 diabetes and other treatments have been unsuccessful.
Before scheduling any surgical procedure such as weight loss surgery, it’s a good idea to get an estimate of costs and find out what your coverage options are. Even for an approved surgery, you may have to pay the Medicare Part A and/or the Part B deductibles before Medicare will pay, plus you may have copayments due. Your weight loss surgery must be performed at an approved facility for Medicare to cover any part of it.
If you’d like to make a shift to a Medicare plan that can offer additional coverage beyond your Original Medicare, you may want to peruse Medicare plan options available within your service area, such as a Medicare Advantage plan. I’ve helped numerous beneficiaries do just that. I’m happy to walk you through your options or email you information; you can request that using the links below. Or, if you prefer, start taking a look at plans by clicking the Compare Plans buttons on this page.