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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.
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:
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:
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:
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:
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.
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.
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?