Medicare does cover weight loss programs, therapy, screenings and surgery if your doctor or health care provider decides that treatment is medically necessary.
In this guide, we review some of the obesity treatment options and weight loss programs that Medicare may cover, including information about eligibility and the potential costs you may pay.
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:
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 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:
In order for Medicare to cover your weight loss bariatric surgery, you must meet the following requirements:
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.
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:
Medicare Part B will also cover your diabetes screenings if two or more of the following situations apply to you:
Medicare covers diabetes screenings in full when they are performed by a health care provider who accepts Medicare assignment.
Medicare Part B will cover your participation in the Medicare Diabetes Prevention Program if you meet the following set of required conditions:
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 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:
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.
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, speak with a licensed insurance agent today by calling TTY Users: 711, 24 hours a day, 7 days a week.
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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