In the United States, reports show that adults who are obese spend close to $2000 more for their medical care than those who have a healthier weight. Even with a financial motivation to lose weight, it can be challenging to start your weight loss journey. If you qualify for Medicare, you may have access to programs and services that may help you.
It’s common knowledge that being overweight or obese reduces the quality of life, but it also increases the risk of disease and other health issues such as:
- Dyslipidemia (unbalanced cholesterol levels)
- Heart disease
- Sleep apnea and other breathing problems
- Various forms of cancer
- Mental health issues
For many people, losing weight is as easy as saying no to a second helping of dessert, but others find it a struggle to do it alone. Today, there are a lot of weight loss programs that you can enroll in, either in person or online, that can help you lose weight by following a specially designed plan that includes diet and exercise regimes.
If you’ve tried it alone, but haven’t been successful with weight loss, you might be wondering if Medicare includes benefits for weight loss programs, so here’s the skinny on how Medicare can help.
How does Medicare cover weight loss programs?
If you’re enrolled in Original Medicare Part A (medical insurance) and Part B (hospital insurance), you may have coverage for a weight loss program if your physician (who accepts Medicare assignment) certifies that it’s medically necessary to prepare you for a surgical procedure or as an essential part of your preventive care plan.
Medicare Part B covers the following weight loss services for those that meet the eligibility requirements:
- Obesity screenings and behavior counseling including dietary assessment if you have a body mass index (BMI) of 30 or above. You are required to get these services from your health care provider in a primary care setting or physician’s office.
- Nutritional counseling which includes medical nutrition therapy (MNT) to treat and manage conditions such as diabetes or kidney disease. You may be eligible if you have diabetes, kidney disease, have had a kidney transplant in the past 36 months, or are on dialysis.
Medicare Part B categorizes obesity screenings, behavioral counseling, and MNT services as preventive care and covers 100 percent of the cost for those who are eligible. You are only responsible for paying your annual Part B deductible if you get these benefits.
Does Medicare cover weight loss surgery?
Medicare may cover bariatric surgery if it’s medically necessary for extreme weight loss, and if you meet the following qualifications:
- You have a BMI of 35 or above.
- You have at least one other health condition related to obesity.
- You have made previous medical attempts to lose weight but weren’t successful.
If you’re admitted to a Medicare-affiliated hospital as an inpatient, Medicare Part A covers your care. You are responsible for paying the Part A deductible for the current benefit period as well as coinsurance and copayments that may apply.
If you have your surgical procedure done in an outpatient setting, Medicare Part B typically pays 80 percent of the final approved costs. You are responsible for the remaining 20 percent after meeting your annual Part B deductible. To get this coverage, your physician and the medical facility must both accept Medicare assignment.
People who have a Medicare Advantage (Part C)plan might have extra benefits that include enrollment in a weight loss program, fitness programs, monthly allowances for over-the-counter products like weight loss supplements, and other related services that aren’t included in Original Medicare Parts A or B. If you’re not sure whether your Medicare Advantage coverage includes these services, you should ask your plan’s representative for details.