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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.
In order to qualify you have to meet specific conditions when it comes to morbid obesity. Your doctor will have to determine 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) provides coverage for some bariatric surgeries like gastric bypass surgery, laparoscopic banding surgery, and gastric sleeve revision.
Medicare Part A will provide coverage for bariatric surgery costs if it is 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 provides 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 around $20,000 to $25,000 on average. This according to the National Institute of Diabetes and Digestive and Kidney Diseases. However, 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 sort of 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 will need make major changes to your diet and exercise regularly.
Bariatric surgeries bring a lot of benefits. The most important being reducing the risks of suffering from a weight-related condition such as high blood pressure, heart disease, and sleep apnea.
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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover dermatology?