Does Medicare Cover Weight Loss Programs?

Original Medicare (Part A and Part B) does cover weight loss programs, therapy, screenings and surgery if your doctor or health care provider decides that treatment is medically necessary.

Medicare Advantage (Part C) plans also cover weight loss programs when they're medically necessary.

Some Medicare Advantage plans also offer free memberships to wellness programs like SilverSneakers, gym memberships and nutritional home meal delivery.

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Medicare Part B covers obesity screenings and counseling

Medicare Part B (medical insurance) covers obesity screenings and behavioral therapy for beneficiaries with a body mass index (BMI) of 30 or more.

These weight loss programs can include:

  • An initial BMI screening
  • Dietary assessments
  • Counseling to help beneficiaries focus on diet and exercise in an effort to lose weight

Your weight loss counseling and screenings are covered in full if received from a primary care doctor who accepts Medicare assignment.

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 ($1,364 per benefit period in 2019).

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 ($185 per year in 2019). 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
  • Obesity
  • 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
  • Overweight
  • 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

Medicare Part B will cover your participation in the Medicare Diabetes Prevention Program if you meet the following set of required conditions:

  • 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

Medicare Part B covers medical nutrition therapy (MNT) for beneficiaries with diabetes or kidney disease and beneficiaries who received a kidney transplant in the past 36 months.

Medicare nutrition therapy services can include:

  • A nutrition and lifestyle assessment
  • Nutritional therapy sessions
  • 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 gym and wellness program memberships

Many Medicare Advantage plans offer memberships to SilverSneakers and other wellness programs as part of the Medicare Advantage plan benefits. SilverSneakers and other programs can help seniors manage their weight loss by getting more active through a number of supported fitness classes.

Some Medicare Advantage plans may also cover healthy food options and home-delivered meals.

Medicare Advantage plans may offer these benefits in addition to all of the Medicare Part A and Part B benefits detailed above.

Medicare Advantage plans can help with your weight loss through programs that support healthy life habits. To learn more and to compare plans that are available where you live, call speak with a licensed insurance agent today.

 

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