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Does Medicare Cover Bariatric Surgery?

Obesity is a complicated health issue that affects almost 40% of Americans and leads to a higher risk of heart disease, stroke, diabetes, and some cancers. When traditional weight loss methods have not been effective, bariatric surgery is an option that may be recommended.

Bariatric surgery (also known as weight loss surgery) refers to any type of surgery on the stomach or intestine that aims to induce weight loss. 

As such, there is a variety of different types of bariatric surgery including gastric bypass, lap-band or gastric sleeve. Your doctor will typically help select a type of surgery that is best suited to you and your health.

Medicare covers a range of different surgical areas, but does medicare cover bariatric surgery? 

Medicare weight loss coverage

Medicare has been covering bariatric surgery for beneficiaries since 2005. However, before Medicare considers approving a bariatric surgical procedure, patients must meet pre-approval requirements.

It is important for patients to ensure that they match these criteria before embarking in the surgery. 

The first step is to prove that the surgery is a last resort following enrollment in at least one medically supervised weight loss program that you have failed. From here, other medical criteria to meet for bariatric surgery to be covered by Medicare include: 

  • A BMI higher than 35. 
  • Been obese for at least five years.
  • Have two or more instances of comorbidity (high blood pressure, heart disease, sleep apnea, high cholesterol, diabetes, or other chronic health issues associated with obesity).
  • There must be proof of medical necessity from your healthcare provider.
  • Have undergone psychological evaluation clearing you for surgery.
  • Tests that prove the thyroid, pituitary and adrenal levels are within normal range and not causing the weight gain.

Once the necessities have been met then Medicare will provide coverage for bariatric surgery.

Which weight-loss surgeries are covered by Medicare?

Should you meet the medical criteria for bariatric surgery, there is a range of different types of weight-loss surgeries that are covered by Medicare. Gastric bypass, lap-band, duodenal switch, and sleeve gastrectomy (gastric sleeve) are all covered under an original Medicare plan. 

If the bariatric surgery is performed at a hospital, it will be covered by Part A, and if it is in an outpatient surgery it will be covered by Part B

The insurer will usually cover 80% of the approved amount but should the patient have a Medicare Advantage Plan or Medicare Supplement Plan, the patient may pay little to nothing.

Bariatric Medicare Coverage

With Original Medicare only covering 80% of costs, bariatric surgery may feel out of reach for some. 

If you are concerned about out-of-pocket expenses associated with bariatric surgery, a Medicare Supplement covers some of the deductibles, copayments, or coinsurance that Original Medicare does not. Medicare Advantage plans cover the same benefits as Original Medicare but offer additional benefits that could see you pay less for bariatric surgery. 

For more information about Medicare Advantage Plans and Supplement Plans available to you, get in touch with an insurance agent at 1-877-829-1109.