Does Medi-Cal Cover Weight Loss Surgery?

Weight loss surgery, also known as bariatric surgery, is a popular and effective way for people with obesity to lose weight and improve their overall health. As with any medical procedure, it’s important to understand the costs associated with the surgery and the available payment options. So, the question remains: Does Medi-Cal cover weight loss surgery?

The answer is yes, Medi-Cal does cover weight loss surgery for eligible individuals. Medi-Cal is the California Medicaid program that provides health care coverage for people with low incomes, and it covers a wide range of health services, including weight loss surgery. Medi-Cal also covers any necessary follow-up care, such as nutrition counseling and exercise programs.

Eligibility Criteria for Weight Loss Surgery Coverage

To be eligible for coverage of weight loss surgery through Medi-Cal, individuals must meet certain criteria. First and foremost, individuals must meet the financial requirements of Medi-Cal, which are based on income and assets. For individuals who are over the age of 21, they must also meet the body mass index (BMI) criteria, which is currently a BMI of 40 or above. Individuals must also have a documented history of weight-related medical conditions, such as hypertension, diabetes, or sleep apnea.

In addition to these criteria, individuals must have attempted other weight loss methods for at least six months prior to considering surgery, such as diet and exercise. Individuals must also have an evaluation from a mental health provider to ensure that they understand the risks associated with weight loss surgery and are committed to long-term lifestyle changes.

Types of Weight Loss Surgery Covered by Medi-Cal

Medi-Cal covers a variety of weight loss surgeries, including gastric sleeve, gastric bypass, lap-band, and duodenal switch. Each of these procedures has its own advantages and disadvantages, and it is important to discuss the options with a qualified medical professional to determine which surgery is right for you. In addition, Medi-Cal will cover any additional procedures that are needed as a result of the weight loss surgery, such as hernia repair or gallbladder removal.

What Other Costs Will Be Covered by Medi-Cal?

In addition to the cost of the actual surgery, Medi-Cal will also cover the cost of any follow-up care that is needed. This may include doctor visits, lab tests, nutrition counseling, and physical therapy. Medi-Cal will also cover any medications that are needed to treat any complications that may arise from the surgery, such as infections or blood clots. It is important to note that Medi-Cal does not cover any non-medically necessary costs, such as cosmetic procedures.

What If I Don’t Qualify for Medi-Cal?

If you do not qualify for Medi-Cal, there are still other options available to you. Some health insurance plans will cover at least part of the cost of weight loss surgery, depending on the individual plan. Additionally, there are a variety of financing options available, such as medical loans and payment plans, which can help to make the cost of weight loss surgery more manageable.

Conclusion

Weight loss surgery can be a life-changing procedure for those struggling with obesity, and it is important to understand the costs associated with the procedure. Fortunately, Medi-Cal does cover weight loss surgery for eligible individuals, and there are also other payment options available for those who do not qualify for Medi-Cal. It is important to speak with a qualified medical professional to learn more about the risks and benefits of weight loss surgery and to discuss payment options.