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Does Medicare Cover Gastric Bypass Surgery

Does Medicare Cover Gastric Bypass Surgery?

In some cases, a healthy diet and proper exercise are not enough for losing weight. In cases like that, some form of surgery may be appropriate. One surgery that can help in weight loss is gastric bypass surgery.

However, not everyone who needs gastric bypass surgery can easily afford it. So a common question many people have is, “Does Medicare cover Gastric Bypass Surgery?”

In this article, we answer that question in clear, plain English. You will also find the average costs of gastric bypass surgery, as well as other helpful info.

Does Medicare Cover Gastric Bypass Surgery?

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

Original Medicare (Medicare Part A and Part B) provides coverage for gastric bypass surgery costs. However, for Medicare to cover gastric bypass surgery, certain conditions must be followed. Those conditions include:

  • A body mass index (BMI) of 35 or higher
  • The patient is suffering from a health condition caused by obesity
  • A person has attempted other ways of losing weight but these attempts did not work

If these conditions are met, Medicare will cover both open and laparoscopic gastric bypass surgery. However, the surgery must occur in a facility approved by either the American College of Surgeons or the American Society for Bariatric Surgery.

Once the conditions are met, Medicare will provide coverage for the surgery along with the following:

  • Lab testing and exams prior to the surgery
  • Surgical services during the surgery
  • Hospital room and board after the procedure
  • Additional testing and blood work after the surgery
  • Medications and durable medical equipment (DME) after the surgery
  • Follow-up visits to the doctor during recovery

Medicare Part A Coverage

Both Medicare Part A and Medicare Part B provide coverage for gastric bypass surgery. Medicare Part A will cover gastric surgery if the procedure will be performed in an inpatient setting such as hospitals. Coverage for gastric bypass surgery performed in an inpatient setting will include:

  • The operation itself
  • Hospital stay for your surgery
  • Medical services you will receive, including medications

Medicare Part B Coverage

Medicare Part B will cover weight loss surgery if the procedure will be performed in an outpatient setting. Coverage for gastric bypass surgery performed in an outpatient setting will include:

  • Visits to the doctors and specialists before and after the surgery
  • Lab tests
  • Medications
  • DME after the surgery

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

Medicare Part D will cover any prescription drugs you may need for gastric bypass surgery.

How Much Does Gastric Bypass Surgery Costs?

Gastric bypass surgery costs an average of around $25,000. The range is from around $20,000 – $30,000 including fees for labs, x-ray, the surgeon, anesthesia and more.

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 CPAP?

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