According to America’s Health Rankings, 28 percent of Americans over the age of 65 are considered obese (having a body mass index of 30 or higher) in 2018.1 Two of the main contributors to senior obesity are slowing metabolism and decreased activity.
Medicare covers some bariatric surgery procedures
Medicare may cover bariatric surgery such as gastric bypass surgery or laparoscopic banding surgery for beneficiaries who meet certain conditions.2
Medicare covers the following types of bariatric surgeries:
Open and laparoscopic Roux-en-Y gastric bypass (RYGBP)
Laparoscopic adjustable gastric banding (LAGB)
Open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS)
In order for Medicare to cover your weight loss bariatric surgery, you must meet the following requirements:
Have a BMI of 35 or higher
Have at least one co-morbidity related to obesity
Have previously undergone medical treatment for obesity, including weight loss programs, but were unsuccessful
Bariatric surgeries performed in an inpatient setting are covered by Medicare Part A (hospital insurance).
If you are admitted as a hospital inpatient, Medicare Part A will help cover your hospital costs after you meet your Part A deductible ($1,600 per benefit period in 2023).
If your bariatric surgery is performed in an outpatient setting, Medicare Part B will help cover your costs after you meet your Part B deductible ($226 per year in 2023).
After you meet your deductible, you are typically responsible for paying 20 percent of the Medicare-approved amount for your weight loss surgery.
Be sure to check with your doctor and your surgeon about how Medicare will cover your weight loss surgery. If you have a Medicare Advantage plan (Medicare Part C), check with your plan provider for more coverage information.
Medicare Part B covers diabetes screenings
If your doctor determines that you are at risk for diabetes or diagnoses you with pre-diabetes, you’re eligible for up to two diabetes screenings each year.
Risk factors for diabetes and pre-diabetes include:
High blood pressure
History of abnormal cholesterol, triglyceride or glucose levels
History of high blood sugar
Medicare Part B will also cover your diabetes screenings if two or more of the following situations apply to you:
Age 65 or older
Family history of diabetes
History of gestational diabetes or delivery of a baby of more than nine pounds
Medicare covers diabetes screenings in full when they are performed by a health care provider who accepts Medicare assignment.
Medicare Part B covers a diabetes prevention program
You have a BMI of 25 or higher (or 23 and higher if you’re Asian)
You’ve never been diagnosed with diabetes (type 1 or type 2) or End-Stage Renal Disease (ESRD)
You haven’t participated in the Medicare Diabetes Prevention Program before
You have a hemoglobin A1c test result between 5.7 and 6.4 percent, a fasting plasma glucose of 110 to 125 mg/dL or a 2-hour plasma glucose of 140 to 199 mg/dL within 12 months before attending the first core session of the prevention program
The Diabetes Prevention Program consists of 16 sessions that take place over six months. The sessions include training, tips and strategies for weight loss and managing weight from a behavior coach.
The initial six months of training are followed by six additional months of less intensive follow-up sessions and 12 more months of ongoing maintenance sessions.
Medicare beneficiaries who meet the requirements for the program pay nothing for the service.
Medicare covers nutrition therapy for some beneficiaries
Help in managing lifestyle factors and healthy weight loss
Follow-up visits to monitor diet
These weight loss and nutrition therapy services are covered by Medicare in full as they are considered preventive and are determined to be medically necessary by your doctor.
Medicare Advantage plans may cover other benefits
Medicare Advantage plans can offer other benefits in addition to all of the Medicare Part A and Part B benefits detailed above. To learn more and to compare plans that are available where you live, call speak with a licensed insurance agent today.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
1 America’s Health Rankings. (2019). [Graph illustration of Obesity in United States in 2018]. Senior Report. Retrieved from www.americashealthrankings.org/explore/senior/measure/obesity_sr/state/ALL.
2 CMS. Coverage Decision Memorandum for Bariatric Surgery for Treatment of Comorbidities Associated with Morbid Obesity. (Feb. 21, 2006). Retrieved from www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=160.
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