For millions of people in the United States, obesity is a serious health problem. For many, dieting and exercise don’t result in the weight loss they need to live a healthier life.
If you are obese and diet and exercise aren’t helping you lose weight, and you’ve exhausted other weight loss methods, your health care provider may suggest that you have some type of bariatric surgery. Weight loss surgery, such as a gastric bypass, can change your digestive system and boost your ability to lose weight.
Procedures like a gastric bypass or a gastric sleeve, limit the amount of food you can eat, making it more difficult to overeat and consume too many calories. When you reduce the number of calories you take in during the day, this can help you lose weight faster and more consistently.
While bariatric surgery can boost weight loss and help you get healthier, it’s major surgery and it doesn’t come without risks and side effects. If you have been considering bariatric surgery, you should have serious discussions with your health care providers about the pros and cons. And, if you decide to go ahead with it, you might need to know whether Medicare insurance covers a part of the cost.
When does Medicare cover bariatric surgery?
If you have Original Medicare Part A (hospital insurance) and Part B (medical insurance), you may have coverage for certain bariatric surgical procedures if you meet the eligibility requirements.
Medicare may cover gastric bypass surgery or laparoscopic banding procedures for those who meet the following criteria:
- Having a body mass index (BMI) of 35 or more
- Having at least one comorbid condition due to being obese such as diabetes, sleep apnea, gall bladder disease, arthritis, etc.
- Having been unsuccessful at previous weight loss attempts through medical means
If these conditions are met, Medicare covers either open gastric bypass surgery or the laparoscopic procedure. Also, you must get the procedure done at a medical facility that accepts Medicare assignment and is certified by the American College of Surgeons or the American Society for Bariatric Surgery.
If you are deemed eligible for the procedure, Medicare also covers other related services, including the following:
- Your initial diagnosis
- Lab tests done before the procedure
- Surgical services necessary for the procedure
- Your hospital room, etc.
- Additional tests or bloodwork necessary after the procedure
- Medication or durable medical equipment necessary during recovery at the medical facility
- Care received from doctors or specialists during recovery
If you are admitted to the hospital as an inpatient for your gastric bypass surgery, Original Medicare Part A covers the cost of your surgical services. Through Part A coverage you are responsible for the deductible of the current benefit period. You may also pay a coinsurance charge if you are an inpatient for over 60 days.
How much does gastric bypass surgery cost without Medicare coverage?
Your final cost for bariatric surgery depends on where you have the procedure done, who your surgeon is, the hospital you use, and the type of surgery and complications you have.
In the United States, the national average cost for bariatric surgery is approximately $15,000.00.