Understanding what is covered by Medicare can be difficult. If you have difficulty understanding if bariatric surgery is covered, continue reading.
Approximately 252,000 Americans had bariatric surgery in 2018. This procedure is considered the most effective obesity treatment. Plus, it's suitable for most adults, including seniors.
As you age, your metabolism slows down. Achy joints, back pain, and other conditions can affect your ability to exercise. Over time, these factors may lead to weight gain and obesity.
Every extra pound puts stress on your spine and joints. Obesity can also increase your risk of heart disease, diabetes, stroke, and premature death. Depending on your particular situation, bariatric surgery may be your only option.
The question is: does Medicare cover this procedure? What about other weight loss treatments? Let's find out!
Medicare and Bariatric Surgery
Bariatric surgery saves thousands of lives each year. This procedure appeals to those with extreme obesity, helping them achieve an average weight. Several techniques are used, including laparoscopic gastric bypass, adjustable gastric band, and others.
Medicare has been covering some of these procedures since 2005. However, beneficiaries must meet specific criteria to have their expenses covered. These are as follows:
- Have a body mass index of 35 or higher
- Have failed to lose weight with other treatments for obesity
- Are diagnosed with one or more obesity-related conditions, like type 2 diabetes, fatty liver disease, or sleep apnea
- Pass a psychological evaluation
Ask your doctor to provide relevant documentation concerning your weight loss efforts to qualify for coverage. Note that he should be the one who recommends bariatric surgery.
What's Covered Under Medicare?
Generally, Medicare covers most surgical procedures for obesity, including but not limited to:
- Sleeve gastrectomy
- Adjustable gastric banding
- Biliopancreatic diversion with duodenal switch
Other procedures, such as gastric balloon surgery, are not covered by Medicare. There is little evidence to support their safety and efficacy.
How much you'll pay depends on your insurance plan. Medicare Part A will only cover the cost of surgery and hospitalization at an approved facility. You won't have to pay anything for the meals and medications received while in the hospital.
Part B covers obesity screenings, medical check-ups, and other examinations before surgery. If you undergo the procedure in a non-hospital facility, your insurance plan will pay for it.
Medicare Part C covers prescription drugs, healthy food delivery, and recovery procedures.
Part D will pay for any medications required after surgery. Medigap plans will cover everything else.
If your body mass index is below 35, you can still use your Medicare coverage to get help.
Part B will pay for behavioral counseling and obesity screenings if you have a body mass index of 30 or higher. These services can make it easier to lose weight through diet and exercise under the guidance of your doctor.
Know Your Financial Options for Bariatric Surgery
When you have extreme obesity, even the most minor things can feel like a chore. Diet alone may not be sufficient to help you lose the extra pounds.
Bariatric surgery is the only option for millions of seniors — and Medicare may cover the costs. Discuss your options with a licensed advisor before choosing a health insurance plan.
In the meantime, see our guide to Medicare coverage and benefits. We'll help you understand how to enroll in Medicare, what's covered under each insurance plan, and more.
If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.