Obesity is a serious health concern. According to the Centers for Disease Control and Prevention, over 90 million adults in the United States are considered obese with a body mass index (BMI) of 30 or higher. With forty percent of those affected 60 years of age or older, seniors are vulnerable to diseases associated with obesity. Obesity can put you at risk for heart disease, stroke, diabetes, certain cancers, and breathing issues, including sleep apnea, among other conditions. Weight loss can help prevent these diseases, but many people struggle to do it alone. If you need help losing weight, talk to your physician.
Weight Loss Options
There are many ways to approach weight loss, including independent programs and group plans. Online fitness and nutrition guides can be helpful, but you should consult your physician before trying anything new. Medicare Part B (Medical Insurance) may help cover some of the costs of your weight loss program. Start with face-to-face individual counseling sessions in your doctor’s office. In this setting, you and your doctor can create a personalized weight loss plan and manage your overall care. Diet and exercise programs help many people reach their weight loss goals. Some Medicare Advantage plans even offer free memberships to fitness centers through SilverSneakers, giving you access to thousands of gyms and fitness classes across the country.
Medicare Coverage for Bariatric Surgery
When other weight loss solutions prove ineffective, your physician may recommend gastric bypass surgery. If medical treatment for obesity is unsuccessful, your BMI is 35 or higher, and you have at least one chronic disease or condition related to obesity, bariatric surgery may be covered by Medicare. There are different types of bariatric surgery, including gastric bypass and laparoscopic banding. The costs associated with your procedure and recovery will depend on your individual needs and where you are treated.
Medicare Part A (Hospital Insurance) helps cover the costs of inpatient hospital care. Coverage will include semi-private rooms, general nursing, medical supplies, and lab tests during your hospital stay. If your procedure is performed in an outpatient setting, Medicare Part B (Medical Insurance) may help cover your costs of medically necessary services including lab tests, X-rays, and medical supplies.
If you have Original Medicare, Part A and Part B will cover many medical expenses, but many people choose to purchase supplemental insurance to lower their out-of-pocket costs. Many Medicare recipients with Original Medicare enroll in a stand-alone Prescription Drug Plan (PDP) to help cover the costs of prescription drugs and some purchase Medigap policies. Medigap, or Medicare Supplement, can help pay some of your expenses, including coinsurance, copayments, and deductibles.
Discuss the potential costs of your bariatric surgery with your physician and medical providers before your procedure. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same coverage as Original Medicare Parts A and B, but many MA plans provide additional benefits, such as prescription drug coverage and out-of-pocket maximums. If you are preparing for gastric bypass surgery, call your plan for exact costs.
Medicare Part D: Medicare Prescription Drug Coverage