Does Medicare Cover Bariatric Surgery? Key Details You Should Know

Sometimes, exercise and diet are not enough to lose weight. However, there are times when surgery is necessary to help a person lose some weight.

But most of the time, surgeries to reduce weight are expensive. So a common question many people have is, “does Medicare cover bariatric surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of bariatric surgeries, as well as other helpful info.

Does Medicare Cover Bariatric Surgery?

The short answer is yes; Medicare may cover the cost of bariatric. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your bariatric surgery. Below we look at what these are so you know what to expect.

To qualify, you have to meet specific conditions when it comes to morbid obesity. Your doctor will have to determine if the surgery is medically necessary. Some other criteria to be eligible include:

Suffering from obesity-related medication condition (at least 1)
You’ve tried other treatments options, but they have not worked
Your body mass index (BMI) is at least 35 kg/m2

Original Medicare (Medicare Part A and Part B) covers some bariatric surgeries like gastric bypass surgery, laparoscopic banding surgery, and gastric sleeve revision.

Medicare Part A will cover bariatric surgery costs if performed in a hospital or an inpatient setting. If the surgery is performed in an outpatient setting, Medicare Part B will cover the costs.

Medicare Advantage plans (Medicare Part C) also provide coverage for bariatric surgeries as they cover everything Original Medicare covers. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.

How Much Does Bariatric Surgery Cost?

Usually, bariatric surgery costs between $15,000 and $25,000 on average. Sometimes it can be even higher than this. With a cost this high, it’s understandable why so many people ask “does Medicare cover bariatric surgery?”

These costs are according to the National Institute of Diabetes and Digestive and Kidney Diseases (part of the NIH).

The costs of bariatric surgery depend on many factors, including:

The type of bariatric surgery you will be having. There are many types of bariatric surgeries. They include gastric bypass surgery, laparoscopic banding surgery, adjustable gastric banding, vertical gastric banding, biliopancreatic diversion, and gastric sleeve revision. Each type of surgery has a different range of costs.
Surgeon’s fee. The surgeon’s fee may differ depending on where you will have the surgery, your surgeon’s expertise, and how complex the procedure is.
The hospital or clinic. Whether you go to a hospital or clinic and where the facility is will also affect the cost.

Aside from that, there may also be additional fees which include:

Consultant fees
Anesthesiologist’s fee
Assistant’s fee
Follow-up treatment

What Is A Bariatric Surgery?

Bariatric surgery, also known as weight loss surgery, is a surgery that helps you lose weight by making changes in your digestive system. It is usually a last resort when diet and exercise do not work. It is often performed after you try to lose weight through exercise and a healthy diet.

But to maintain your health after surgery, you must make major changes to your diet and exercise regularly.

Bariatric surgeries bring a lot of benefits. The most important is reducing the risks of weight-related conditions such as high blood pressure, heart disease, and sleep apnea.

Who Is a Good Candidate For Weight Loss Surgery?

Weight-loss surgery is a treatment option for people who struggle with obesity and can’t lose weight through other means.

Doctors will often use your Body Mass Index (BMI) to determine if you are a good candidate. Those who have a BMI of 35 or higher may require surgery. If you have a BMI between 30 and 35 and have type 2 diabetes, you may also be considered for surgery.

Weight-loss surgery is also a good option for people with serious obesity-related health problems like type 2 diabetes or sleep apnea. The surgery can help improve these conditions.

Risks of Bariatric Surgery

Weight-loss surgery, like any other major procedure, comes with potential health risks. There are both short and long-term risks.

Short term risks include:

Excessive bleeding
Infection
Blood clots
Leaks in the gastrointestinal system

Long-term risks and complications can vary depending on the type of surgery and can include:

Bowel obstruction
Gallstones
Hernias
Low blood sugar
Malnutrition
Ulcers
Vomiting
Acid reflux
The need for a revision surgery

How Does the Surgery Work?

Bariatric surgery is performed in the hospital using general anesthesia. This means you’ll be asleep during the surgery.

The specifics of the surgery depend on your situation and the type of weight-loss surgery you have. Some surgeries are performed with large incisions using a scalpel.

Others, however, are done laparoscopically, using small incisions and a camera-equipped instrument. Laparoscopic surgery is less invasive and typically results in a faster recovery, but it may not be suitable for everyone.

The surgery usually takes several hours and after you will be in a recovery room where medical staff will monitor you for any complications. Depending on your situation, you may need to stay in the hospital for a few days.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.