Weight loss surgery is becoming a popular choice for those who have struggled to lose weight and have a body mass index over 40. It’s a major decision to make, and not everyone is able to afford it. That’s why many people are wondering if Medicare will cover the cost of weight loss surgery. The answer is yes, Medicare may cover the costs of certain types of weight loss surgery.
Types of Weight Loss Surgery Covered by Medicare
Medicare covers two types of weight loss surgery: gastric bypass and gastric banding. Gastric bypass surgery is a procedure in which the stomach is divided into two parts. The smaller part is connected to the small intestine, which limits the amount of food the stomach can hold. Gastric banding is a procedure in which an adjustable band is placed around the top of the stomach, forming a pouch. This pouch limits the amount of food that can be eaten at one time.
Qualifying for Medicare Coverage of Weight Loss Surgery
To qualify for Medicare coverage of weight loss surgery, you must meet certain criteria. You must be obese, with a body mass index (BMI) over 40. You must also be suffering from obesity-related health problems such as diabetes, high blood pressure, or sleep apnea. In some cases, you may be able to qualify if you have a BMI over 35 and obesity-related health problems.
In addition, you must have attempted to lose weight through diet and exercise but have been unsuccessful. You must also be willing to participate in a program of lifestyle changes, such as a diet and exercise plan, after the surgery. Your doctor must certify that you meet these criteria in order for Medicare to cover the costs of weight loss surgery.
What Medicare Covers for Weight Loss Surgery
Medicare covers the cost of approved weight loss surgeries, including the surgeon’s fees, hospital fees, and other related costs. It does not cover the cost of follow-up care, such as counseling and nutrition counseling. You may be responsible for some of these costs.
Medicare vs. Private Insurance Coverage of Weight Loss Surgery
Medicare may cover the costs of weight loss surgery, but it is important to compare private insurance plans as well. Private insurance plans may offer more comprehensive coverage than Medicare, such as coverage for follow-up care. Private insurance plans may also have different criteria for eligibility, such as a lower body mass index requirement.
The Bottom Line
Weight loss surgery can be an effective way to lose weight and improve your health. Medicare may cover the costs of certain types of weight loss surgery, but it is important to compare private insurance plans as well. Be sure to meet the criteria for eligibility and discuss your options with your doctor before making a decision.