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does Medicare cover Optifast weight loss programs

Does Medicare Cover Optifast Weight Loss Programs?

Obesity can cause serious medical conditions ranging from joint deterioration to heart diseases. One way people try to lose unnecessary weight is by participating in the Optifast weight loss program. 

If that program is something you are considering, you may have the question “does Medicare cover Optifast weight loss programs?” In this article, we answer that question in clear, plain English. You’ll also find some information about the costs of the Optifast program.

Does Medicare Cover Optifast Weight Loss Programs?

The short answer is no. In most cases, Medicare will not cover the cost of the Optifast weight loss program. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Optifast weight loss program.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for the Optifast weight loss program. So that means you will have to pay 100 percent of the cost if you want to do this program.

Original Medicare does not provide coverage for the Optifast weight loss program because they mainly cover medically necessary services, equipment, and treatment. 

In fact, Original Medicare does not provide any coverage for weight loss programs such as the Optifast weight loss program. That is because Original Medicare excludes weight loss supplements and programs from its coverage. The reason for this is because these types of things are viewed as lifestyle choices rather than medically necessary treatments for an illness. 

However, if you are a Medicare beneficiary and you need exercise therapy as part of rehabilitation after a surgical procedure, Original Medicare may provide coverage for it. The rehabilitation must be ordered by your healthcare provider and take place in a skilled nursing facility or an outpatient treatment program.

Medicare Part A will provide coverage if it takes place in an inpatient setting such as a skilled nursing facility. Medicare Part B will provide coverage if it takes place in an outpatient setting. 

Part B may also provide coverage for a weight loss program such as the Optifast weight loss program if it is necessary for preparation for weight loss surgery. A weight loss program may be necessary before a weight loss surgery to reduce the risks of complications during the procedure. And it can also give you a better chance of recovery after.

Part C Coverage for Optifast Weight Loss Programs

However, many Medicare Advantage plans (Medicare Part C) provide coverage for Optifast weight loss programs. Medicare Advantage plans cover everything Original Medicare covers. But they also provide coverage for treatments, services and programs that Original Medicare does not. Exactly what a plan covers and how much the associated costs are will vary depending on what plan you have.

Some Medicare Part C plans provide coverage for gym and fitness memberships as well as weight loss programs. Your Medicare Part C plan may offer gym membership plans or membership discounts for your overall health and wellness.

How Much Does It Cost To Participate In A Optifast Weight Loss Program?

Optifast weight loss programs usually cost about $150 per week. This varies depending on what point you are at in the program.

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 Botox for overactive bladder?

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