Weight gain is pretty common as we get older and physical activity becomes more difficult. Though some people can still perform a few light exercises to burn the fat, other people cannot and may need surgery if they are obese.
If you are struggling with this and considering surgery, you may be wondering, “does Medicare cover weight loss revision surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of weight loss revision surgery and other helpful info.
Does Medicare Cover Weight Loss Revision Surgery?
The short answer is yes; Medicare will cover the cost of weight loss revision 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 weight loss revision 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 weight loss revision surgery. Parts A and B provide coverage for some weight loss surgeries but not all of them. Among those Original Medicare covers include weight loss revision surgery.
Original Medicare provides coverage for your weight loss revision surgery if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
If your first weight loss surgery did not go too well and you think that a weight loss revision surgery may help, you and your healthcare provider must discuss it first. When discussing your potential weight loss revision surgery, you’ll want to be honest and open with your doctor. This will lead to better, safer decisions regarding your surgery and outcome.
Aside from weight loss revision surgery, Original Medicare also provides coverage for other weight-loss surgeries. Medicare provides coverage for weight-loss surgery if the patient has:
- A BMI of 35 or higher
- Tried other ways to treat obesity but it did not work
- A medical condition caused by his/her obesity, such as high cholesterol or type 2 diabetes
Original Medicare provides coverage for three more types of weight loss surgeries such as:
- Roux-en-Y gastric bypass (both open and laparoscopic)
- Biliopancreatic diversion with duodenal switch (both open and laparoscopic)
- Adjustable gastric banding (laparoscopic)
Part C Coverage for Weight Loss Revision Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for weight loss revision surgery. Advantage plans are required to cover everything that Original Medicare does. But these plans also cover many other things as well. The additional treatments, procedures, etc. they cover and how much these things cost vary depending on what Medicare Advantage plan you have.
How Much Does It Cost To Undergo Weight Loss Revision Surgery?
A gastric bypass revision surgery may cost somewhere from $20,000 to $30,000. This price varies based on the provider and the specifics of your situation.
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 long term care?