Obesity is a complicated health issue. With almost 40% of Americans currently considered obese and at a higher risk for the leading causes of death, including heart disease, stroke, diabetes, and some cancers, it is essential to consider all the options when treating it. Obesity has serious physical and mental health consequences, and when traditional weight loss methods have not been effective, a physician may recommend bariatric surgery.
What is bariatric surgery?
Bariatric surgery refers to any surgical procedure on the stomach or intestines to induce weight loss. The three most common types of bariatric surgery are:
- Gastric sleeve surgery (sleeve gastrectomy)
- Gastric bypass
- Lap band
Less common procedures that fall under the bariatric surgery umbrella include the duodenal switch and gastric balloon.
Medicare Coverage for Weight Loss:
Obesity Screening & Counseling
Before considering bariatric surgery, you will need to work with your physician to explore less invasive methods of losing weight. This will start with obesity screening, including a Body Mass Index (BMI) test, and counseling. If the counseling takes place in a primary care setting, it will be covered by Medicare Part B for individuals with a BMI of 30 or more.
Bariatric Surgery
Medicare covers some bariatric surgical procedures, such as gastric bypass and laparoscopic banding surgery, when a patient meets specific morbid obesity criteria. Medicare Part A will help pay for the costs of inpatient hospital costs, but if your bariatric surgery is performed as an outpatient, Part B will help cover the costs of your doctor services and supplies. Part A or Part B deductibles will apply.
What You Will Pay
The exact cost of your procedure will be based on your insurance plan and the specific services and supplies you will need during and after your surgery. Original Medicare covers many costs, but if you are concerned about out-of-pocket expenses, you may want to consider purchasing a Medigap, or Medicare Supplement, plan to help cover some of the deductibles, copayments, or coinsurance that Original Medicare does not. Medicare Advantage (MA) plans must cover the same benefits as Original Medicare, but many offer additional benefits. Call your plan for specific details regarding the coverage of bariatric surgery.