Common Questions

Does Medicaid Cover Weight Loss Surgery?

Medicaid may cover weight loss surgery and other weight loss programs in a number of states, though coverage can vary from one state to another. Learn more about Medicaid weight loss programs and find out how to confirm your state Medicaid program's benefits.

Medicaid provides coverage for a variety of weight loss programs, but does it cover the cost of weight loss surgery?

Medicaid may cover weight loss surgery in some states

Medicaid coverage can vary a lot by state, but weight loss surgery may be covered by many state Medicaid programs under the following conditions:

  • Males are over the age of 15 and females are over the age of 13.

  • Body Mass Index (BMI) is over 35 with at least one comorbidity such as sleep apnea, high blood pressure, high cholesterol or diabetes.

  • A psychological exam is taken and passed.

  • There is documentation that the beneficiary was unsuccessful at managing comorbidities with standard treatment.

  • Nutritional and psychological services are available before and after surgery.

  • There is a note from a doctor stating the surgery is medically necessary to achieve and maintain a healthy weight.

  • The beneficiary has a clear understanding that diet and lifestyle changes will be necessary after the procedure.

  • The beneficiary participates in a medically supervised weight loss program for six months within one year of the surgery. 

In addition, the weight loss surgery must typically be performed at a facility that has achieved a Bariatric Center for Excellence designation, which is awarded to facilities that have demonstrated a history of excellence in bariatric surgery. 

Medicaid coverage for weight loss surgery will differ by state, and the above requirements represent just an example of the type of standards that might have to be met for a procedure to be covered under Medicaid. For information about weight loss surgery benefits specific to where you live, contact your state Medicaid program.

Which weight loss surgeries can Medicaid cover?

Again, Medicaid coverage of weight loss surgery will depend on the state, but some of the procedures that may be covered under the right circumstances include:

  • Gastric bypass surgery
  • Lap band surgery
  • Gastric sleeve surgery

When will Medicaid not cover weight loss surgery?

Aside from state-specific eligibility requirements, there are a few factors that will typically exclude someone from Medicaid coverage of weight loss surgery. These include:

  • Pregnancy
  • Malignant cancer
  • Long-term steroid use
  • Inflammatory bowel disease
  • Chronic pancreatitis
  • Psychological treatment that may interfere with post-operative lifestyle changes

What other weight loss services are covered by Medicaid?

In addition to weight loss surgery, Medicaid can also cover a variety of other weight loss services in many states. 

Obesity screenings

Medicaid covers obesity screenings for people under the age of 21 in all states. Select states offer this benefit to adults as well. 

Weight loss counseling and education

Certain state Medicaid programs will provide coverage of weight loss interventions, education and counseling designed to encourage healthier eating and exercise. 

Weight loss medication

Weight loss pills may be covered by Medicaid in some states as well as medications for things like diabetes and heart disease, which are commonly prescribed to people who are overweight. 

Are weight loss services and surgeries covered by Medicaid-Medicare plans?

A Medicare Special Needs Plan (SNP) is a certain type of Medicare Advantage plan that is designed for the specific needs of someone with a particular health condition. Many Special Needs Plans are designed for people with diabetes and may feature enhanced benefits for weight loss surgery and other weight loss services and products. 

Some Special Needs Plans are called Dual Eligible Special Needs Plans (D-SNPs) and are designed for people who are eligible for both Medicaid and Medicare. Speak to a licensed insurance agent for more information about Medicare Advantage Special Needs Plans. 

If you are eligible for both Medicare and Medicaid, contact a licensed insurance agent to learn more about Dual-eligible Special Needs Plans and find out if any such plans are available where you live. 

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Christian

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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