Does Medicare Cover Weight Loss Programs?

Losing weight is not easy. But it is achievable and, in some cases, very necessary if excess weight is causing serious medical issues.

While “exercise and eat right” is the common refrain when it comes to losing weight, not everyone can do this on their own. It may take the help of another person. Preferably from a professional.

Fortunately, there are a number of excellent weight loss programs that can help those who need help to lose weight and improve their health.

So a common question many people have is, “does Medicare cover Weight Loss Programs?” In this article, we answer this question in clear, plain English.

Does Medicare Cover Weight Loss Programs?

The short answer is yes; Medicare will cover the cost of weight loss programs. 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 weight loss programs. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) does cover weight loss programs.

Medicare Part B provides coverage for obesity screenings and behavioral therapy. But only if you have a Body Mass Index (BMI), of 30 or more.

Another weight loss program that Medicare Part B covers are dietary assessments. However, for Medicare Part B to cover these weight loss programs’ costs, the program must be medically necessary. That’s a determination that your doctor must make.

Once accepted by Medicare Part B, they will cover the costs of weight loss programs in full.

Other Weight Loss Options Medicare May Cover

Aside from weight loss programs, Medicare also covers the following:

Bariatric surgeries
Diabetes screenings
Diabetes prevention programs
Nutrition therapy

Medicare provides coverage for the following bariatric surgeries:

Open and laparoscopic Roux-en-Y gastric bypass
Laparoscopic adjustable gastric banding
Open and laparoscopic biliopancreatic diversion with duodenal switch

Bariatric Surgery

For Medicare to cover bariatric surgeries, certain conditions must be met. One is that you have a BMI of 35 or higher. Also, you have already tried other medical treatments for obesity but they have not been successful. This may include weight loss programs. Another requirement is having co-morbidity due to obesity.

Medicare Part A covers inpatient bariatric surgeries, while Medicare Part B covers outpatient bariatric surgeries.

Diabetes Coverage

Coverage for diabetes screenings and diabetes prevention programs falls under Medicare Part B. Medicare Part B will cover two diabetes screenings if your doctor determines that you are at risk of having diabetes (or if you are diagnosed with pre-diabetes).

Medicare Part B has a diabetes prevention program you can enter. It is for those with a BMI of at least 23 or higher, who have not been diagnosed with diabetes type 1 or 2, and if they have not yet participated in the Medicare diabetes program.

Medicare Advantage Weight Loss Coverage

Medicare Advantage plans (Medicare Part C) also provide coverage for weight loss programs. Many Medicare Part C plans offer membership to SilverSneakers and other wellness programs as part of their benefits.

Some Medicare Part C plans may also cover healthy food options and home-delivered meals.

These plans cover everything Original Medicare covers as well as offer some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

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.