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For many, the key to losing weight is through proper exercise and a healthy diet. Doctors and weight loss experts have been pounding that into us for years.
However, for some people, diet and exercise don’t work. And, in these cases, weight loss surgery is needed to help them lose weight.
But weight loss surgery is not cheap. And many who need it are not able to afford it without help from insurance.
So a common question many people have is, “Does Medicare cover Weight Loss Surgeries?” In this article, we answer that question in clear, plain English. You will also find the average costs of weight loss surgeries and other helpful info.
Does Medicare Cover Weight Loss Surgeries?
The short answer is no. In most cases, Medicare will not cover the cost of most weight-loss surgeries. 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 weight loss surgery.
Original Medicare (Medicare Part A and Part B) does not provide coverage for most weight-loss surgeries.
However, there are certain conditions under which Medicare may pick up at least part of the tab. For a Medicare beneficiary to be eligible for a weight loss surgery, he/she must have a Body Mass Index (BMI) of 35 or higher. He/she also must have tried other treatments for obesity, but they did not work.
In addition, you must have an underlying medical condition due to obesity in order to get coverage. Some of these medical conditions are:
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Sleep apnea
- Certain types of cancer
Types of Weight Loss Surgeries Medicare May Cover
Medicare provides coverage for three types of weight-loss surgeries. The weight-loss surgeries that Medicare covers are:
- Open and laparoscopic Roux-en-Y gastric bypass
- Open and laparoscopic biliopancreatic diversion with duodenal switch
- Laparoscopic adjustable gastric banding
A key factor in what Medicare will cover is whether or not a procedure is medically necessary. In the case of weight loss surgery, it is medically necessary if it meets the criteria we mention above.
However, weight loss surgery that is done primarily for cosmetic reasons is not eligible for coverage. There are also specific types of weight loss surgeries that Medicare will not cover. These include:
- Open and laparoscopic vertical banded gastroplasty
- Open and laparoscopic sleeve gastrectomy
- Gastric balloon surgery
- Open adjustable gastric banding
- Intestinal bypass
Medicare Advantage plans (Medicare Part C) may also provide coverage for weight loss surgery. Medicare Advantage plans cover everything Original Medicare covers as well as offer some additional benefits. However, what it covers and what you will pay out of pocket will vary depending on the specifics of your plan.
How Much Does Weight Loss Surgery Cost?
In the US, weight loss surgery will cost an average of $20,000. This depends on what type of surgery you have, what facility you go to and what the doctor’s fee is. This may not include other fees such as anesthesia, doctor visits before and after surgery, 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.
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 genetic testing for cancer?