Does Medicare Cover Lap Band Surgery?

Original Medicare provides coverage for a couple of weight-loss surgeries, as long as they are medically necessary to treat an illness caused by obesity. Original Medicare will not provide coverage for weight loss surgeries if done for a cosmetic reason. Is lap band surgery one of the surgeries they cover?

This is why a lot of people have the question “does Medicare cover lap band surgery?” In this article, we answer that question in clear, plain English.

Does Medicare Cover Lap Band Surgery?

The short answer is yes. Medicare will cover the cost of lap band 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 lap band surgery. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for lap band surgery. They will cover this type of surgery if your medical provider considers it medically necessary. In fact, the operation must also be first ordered by your doctor. Otherwise Original Medicare will not provide coverage.

Also, for Original Medicare to provide coverage for your weight-loss surgery, you must have:

A BMI of 35 or higher
Tried other ways to treat obesity that did not work
A medical condition caused by their obesity, such as high cholesterol or type 2 diabetes
An order from your healthcare provider stating why you need to undergo lap band surgery

Coverage for lap band surgery is provided by Medicare Part A if your lap band surgery takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. From days 60 to 90, Medicare Part A will still provide coverage but you will pay a copay of $371 per day. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will pay for a copayment of $742 per day.

On the other hand, coverage for lap band surgery is provided by Medicare Part B when it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of lap band surgery. You will pay for the remaining 20 percent.

Part C and Part D Coverage for Lap Band Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for lap band surgery. This is because Medicare Advantage plans are required to cover all the same treatments, procedures, services, etc. that Original Medicare covers.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you. Medicare Part D plans also provide coverage for medications that you need after lap band surgery.

How Much Does Lap Band Surgery Cost?

A lap band surgery may cost somewhere from $12,000 to $25,000. This cost will vary depending on the provider.

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.