Medicare does not pay for weight loss surgery, but there are ways to receive the coverage you need. First, if you are obese or just overweight, see your doctor. He or she can evaluate your medical history and recommend treatment. There are often a number of conditions that will qualify you for certain benefits, including gastric bypass surgery, weight loss surgery, hip or knee replacements, or other health conditions.
You can also get Medicare part A and B through private insurance companies. These programs do not cover surgeries, but if you have a health condition that qualifies you for Medicare benefits, you may qualify for part A or B. Both of these programs have similar guidelines and payment rates. If you are under the age of 65, and have obesity as a chronic condition, you may qualify for Medicaid if your state has expanded Medicaid. Even if you don’t have Medicaid, most people qualify for Medicare benefits once they are in the program.
Medicare Part A and B are both managed by private insurance companies. Private companies are not always as highly rated as Medicare. Some Part A plans pay a higher percentage of your expenses than others. Unfortunately, not all private companies take into account obesity as a qualifying condition. If you would like to get Medicare part A and B, you must select a non-fee doctor and select an eligible procedure. If you do not select a procedure that meets the guidelines, the coverage is canceled.
Many qualified patients choose gastric bypass surgery or a similar procedure to reduce the size of their stomach. Does Medicare cover gastric bypass? Yes. Many gastric bypass procedures are performed during routine doctor visits. If your physician does not suspect a more serious problem or you have not attempted weight loss through diet and exercise, many insurance plans cover it.
What does Medicare cover? As with gastric bypass, gastric Band and gastric sleeve surgery to reduce the size of your stomach. The difference is that these procedures bypass the lower part of the small intestine (the duodenum) and travel straight to the stomach. Unlike bariatric surgery which requires making changes to the small intestine, the Food and Drug Administration allows modified foods to pass through after a gastric bypass.
When are you eligible? Like any invasive procedure, there are certain age limits. Before Medicare can pay for weight loss surgery, it must determine that you have one of several conditions: Hypertension, Chronic Obstructive Pulmonary Disease, Obesity, or Gallstones. Medicare will refuse to cover surgery if you have any other condition.
How much does Medicare cover? As with most medical treatments, Medicare charges the lowest cost for the procedure. Because gastric band and gastric sleeve surgeries are so expensive, your insurance likely covers some of the cost. However, if you have a history of serious health problems – including obesity, hypertension or gallstones – you may need to consider other options. If you’re at risk for developing malnutrition, low blood pressure, or chronic lung disease, you may also want to consider other weight-loss methods. Keep in mind that gastric band use reduces the amount of food you’re able to eat, which is why it’s important to watch your weight – even after you lose the weight.
Will Medicare help pay for part of my gastric bypass? If your obesity is severe, your surgeon will likely recommend a gastric bypass procedure as the least invasive way to lose weight. Unfortunately, as with most surgeries, not all hospitals will accept payments for this type of procedure. Medicare will only help cover the most basic portion of the surgery.