Weight loss surgery can be an effective treatment for those people who are struggling to lose weight through non-surgical methods, like dieting and exercise. If you or a loved one receives Medicare benefits and may be considering weight loss surgery to overcome obesity, there are several factors to consider.

Understanding Weight Loss Surgery

The Mayo Clinic categorizes weight loss surgery according to the way in which it changes how the body responds to food: restriction or malabsorption. In a surgery that uses a restriction method, the stomach is altered in order to limit the volume of food it can hold. A surgery that alters the length or use of the small intestine changes how many calories the body can absorb.

These are the four most common weight loss surgeries:

  • Roux-en-Y gastric bypass. This procedure creates a pouch that is small and located at the top of the stomach, then connected directly to the small intestine. This limits both the amount of food the pouch can hold and the number of calories the body absorbs.
  • Laparoscopic gastric band (LAGB). An adjustable band is placed around the stomach to create a small pouch. In order to adjust the band, fluid is injected into a balloon that tightens the band around the top of the stomach, reducing the volume of food needed to feel full.
  • Sleeve gastrectomy. In this surgery, up to 75 percent of a person’s stomach is removed in order to reduce how much food the remaining stomach size, which now resembles a sleeve or tube, can hold.
  • Biliopancreatic diversion. This procedure can be performed in two different ways and both reduce the volume of food the stomach will hold and the number of calories the body absorbs. The first method simply removes part of the stomach and connects the remaining stomach to a lower part of the small intestine. The other method removes a different part of the stomach and leaves the pylorus vale, which manages food drainage, intact.

You can discuss with your doctor which weight loss surgery may be best for your circumstances. Several factors, including the need to take extra supplements or change certain behavioral patterns once the surgery is complete, may help determine if a particular procedure is more appropriate in comparison to another.

Risks Associated with Weight Loss Surgery

With any surgery related to weight loss, there may be a heightened risk of internal bleeding, infection or blood clots, especially if mobility is impaired during recovery. Surgical procedures for weight loss that remove part of the stomach or alter how the small intestine connects with the stomach are irreversible.

Risks that are specific to weight loss surgery can also include developing gallstones or conditions related to nutritional deficiency, such as anemia and osteoporosis. The risk for these issues is higher in patients who have had a surgery that impacts their ability to absorb calories and therefore the different nutrients in their food.

Some patients also describe gastrointestinal discomfort when eating certain types of food, particularly highly refined and processed foods that may contain a lot of sugar.

Medicare Coverage for Weight Loss Surgery

Medicare recipients who meet the criteria for medically necessary weight loss surgery are typically considered morbidly obese, which means they have a body mass index greater than 35. You may also qualify for a medically necessary weight loss surgery if you have health conditions related to obesity, such as type 2 diabetes.

In either case, it must also be shown that other treatments have been unsuccessful in helping you to lose weight in order for Medicare to consider weight loss surgery medically necessary. Once medical necessity is determined, Original Medicare, Part A and Part B, may help cover the costs associated with the procedure. Part B may cover doctor visits and lab work to diagnose your needs. Part A may help cover your surgery if you have been formally admitted into a Medicare-approved hospital. You may be responsible for copayments and coinsurance, and your deductible will apply. If your physician prescribes medication during your recovery, a Prescription Drug Plan (PDP) can help lower your out-of-pocket costs.

More coverage options may be available through a Medicare Advantage (MA) plan. If you choose to get your Medicare coverage through an MA plan offered by a private insurance company that contacts with Medicare, you will have the same Part A and Part B benefits as Original Medicare, but many MA plans include additional coverage, such as prescription drug coverage and an annual out-of-pocket maximum. Check with your plan to determine your exact costs for weight loss surgery.

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