Does Medicare Cover Weight Loss Programs?
Being overweight or obese can become a serious health issue at any age. For those who are older, untreated obesity may reduce mobility, threaten independence, and quality of life. It can also lead to serious health issues such as:
- Type two diabetes
- Hypertension
- Certain forms of cancer
- Heart disease
- Stroke
- High cholesterol levels
- Gallbladder disease
- Fatty liver
- Breathing problems including sleep apnea
- Osteoarthritis
- Chronic back pain
If you have a substantial amount of weight to lose, it can be a daunting task if you go at it alone. Fortunately, medical professionals can help by providing information about nutrition and the right types of exercise. Today, there are many reputable weight loss programs that offer structured plans with extra support, like lifestyle or behavior counseling, to boost your weight loss success.
If you’re considering enrolling in a weight loss program, you should get advice from your primary care provider to ensure that the program is right for your health and weight loss needs. Your Medicare benefits may help you cover the cost.
Does Medicare cover weight loss programs?
If you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), you might be eligible for some preventive and surgical services that are focused on helping you reach a healthy weight. While Medicare doesn’t typically cover conventional weight loss programs, it does cover the following related services:
Weight loss counseling is a preventive service available through Original Medicare Part B if your BMI is 30 or higher. The counseling sessions include an obesity screening, dietary assessment, and behavior therapy.
To be eligible for Medicare coverage, these services must be provided by a physician, physician assistant, clinical nurse specialist, or a nurse practitioner who accepts Medicare assignment, and in a primary care facility that also accepts Medicare assignment.
Medicare Part B covers face-to-face weight loss counseling meetings based on the following schedule:
- Once a week during the first month.
- Once every other week during months 2 through 6.
- Once a month for month 7 through month 12 (which is the limit) if you’ve lost at least 6.6 pounds by month 6. If you don’t reach that goal, you might be eligible to begin the counseling sessions again after waiting six months.
Original Medicare Part B covers 100 percent of the cost of preventive services if you meet eligibility requirements.
Medicare also covers certain types of bariatric and metabolic surgical procedures if you have a BMI of at least 35, you have other medical conditions such as diabetes, hypertension, high cholesterol, sleep apnea, etc. Your physician must also certify that other weight loss treatments haven’t been successful in the past.
The most common types of bariatric procedures that Medicare covers are:
- Gastric bypass surgery
- An adjustable gastric banding
- Biliopancreatic diversion with a duodenal switch
- A sleeve gastrectomy
- A vertical gastric banding
Original Medicare Part B covers these procedures if they take place in an outpatient setting. Part B covers 80 percent of the final approved cost, and you pay the remaining 20 percent after meeting your annual Part B deductible. You may also pay coinsurance to the outpatient hospital or clinic as well as copayments for physicians or specialists.
If you have bariatric surgery as a hospital inpatient, Medicare Part A covers the cost, and you are responsible for paying the Part A deductible for the benefit period. If your hospital stay exceeds 60 days, you must also pay coinsurance costs.
Medicare Advantage (Part C) plans are required to provide the same benefits as Original Medicare Parts A and B, at minimum. Most Part C plans also cover extra benefits, so your policy may include coverage for conventional weight loss programs. You should discuss your benefit options with your provider if you aren’t sure about the details.