Does Medicare Cover Weight-loss Surgery?

Last Updated : 10/05/20183 min read

If you are covered under Original Medicare (Part A and Part B), and your doctor has diagnosed you with “morbid obesity,” Medicare might cover your weight-loss surgery (also called bariatric surgery). Here’s what you may want to know.

What’s “morbid obesity?”

Also called severe obesity, the National Institutes of Health (NIH) defines it as the condition of a Body Mass Index (BMI) of 40 or higher.

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The Body Mass Index, the NIH website says, is a calculation based on your height and weight.

What are the different types of weight-loss surgery?

Bariatric surgery, or weight-loss surgery, may refer to any of several types of surgical procedures, such as adjustable gastric band surgery, according to the National Institutes of Health (NIH).

These procedures basically work in one of two ways, either by limiting the amount of food you can actually take into your stomach, or changing the way you digest food or absorb nutrients.

According to the Mayo Clinic, major weight-loss surgical procedures may carry certain risks including (but not limited to) infection, bleeding, anesthesia complications, and blood clots. Your health-care provider can help you determine if the benefits of bariatric surgery outweigh any potential risks. It’s also important to know that anyone who undergoes weight-loss surgery might need regular medical supervision for life.

Will Medicare cover weight-loss surgery?

Medicare might cover eligible, medically necessary costs associated with gastric bypass or gastric band weight-loss surgery if your doctor determines you have morbid obesity and have qualifying obesity-related health conditions. Keep in mind the following, however:

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  • You may have to pay any applicable Part A or Part B deductible, copayment, or coinsurance.
  • Your costs may be different if you have weight-loss surgeryas a hospital inpatient versus an outpatient facility.
  • You can ask your health-care provider, hospital, or surgical facility to estimate what you will pay for your weight-loss surgery and any care afterward.
  • Your doctor may recommend some services or procedures Medicare doesn’t cover; if this happens, you may have to pay the full cost of these services.
  • If you are enrolled in a Medicare health plan, you can contact your plan’s customer service department for more information about what the plan pays and what your costs will be for bariatric surgery.

I can help you understand your Medicare options for bariatric surgery if you need more assistance. To get information via email or to schedule a telephone consultation, click one of the links below. You can view a list of plans in your area you may qualify for by clicking the “Compare Plans” button. For immediate assistance, please call me or one of eHealth’s other licensed insurance agents at 1-844-847-2660 (TTY users can call 711) Monday through Friday, 8AM to 8PM ET.

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