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Does Medicare Cover Bariatric Surgery?

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By Daniel Petkevich
Dec 27, 2022

The answer depends on your situation

The answer to whether Medicare covers bariatric surgery is based on the reason behind it. If your doctor deems the procedure medically necessary, you will have coverage. If the reason is primarily

cosmetic

, you will likely not have coverage. Read more to find out about coverage of bariatric surgery on Medicare.

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Overview of Bariatric Surgery

Bariatric surgery is an effective and long-lasting solution for individuals who are severely obese. It involves the surgical alteration of the digestive tract to help people reduce their caloric intake, leading to significant weight loss. In order to be considered eligible for bariatric surgery, patients must meet certain medical criteria set by their doctors or insurance providers.

What is considered medically necessary for Medicare to cover bariatric surgery?

In order for Medicare to cover bariatric surgery, the procedure must be medically necessary. This means that your doctor or healthcare provider must determine that you are severely obese and unable to lose weight through diet and exercise alone. Additionally, your doctor must document that the potential health benefits of the surgery outweigh the associated risks.

Eligibility requirements for Medicare coverage of bariatric surgery

In order to be eligible for Medicare to cover bariatric surgery, you must meet the following medical criteria:
  • You have a body mass index (BMI) of at least 35
  • You have at least one obesity-related condition, such as type 2 diabetes, high blood pressure, or sleep apnea.
  • You have tried other weight loss methods, such as a supervised diet and exercise program, and have been unable to achieve and maintain significant weight loss.
Medicare may cover the cost of the surgery and related hospital stays. However, you may be responsible for paying some out-of-pocket costs, such as deductibles, copayments, and coinsurance. The best way to avoid these out-of-pocket costs is with

Medicare Supplement Plan G

.

Potential risks and complications associated with the procedure

As with any surgical procedure, there are potential risks and complications associated with bariatric surgery. These include infection, bleeding, hernias, and even death. It’s important to talk to your doctor about the risks associated with the procedure before deciding whether or not to proceed.

Benefits of weight loss through bariatric surgery

The benefits of bariatric surgery can be far-reaching. Along with helping you achieve and maintain significant weight loss, the procedure may also reduce or even eliminate obesity-related conditions such as type 2 diabetes, high blood pressure, and sleep apnea.

How to find a qualified surgeon who accepts Medicare insurance

If you have decided to pursue bariatric surgery and your doctor has determined that it is medically necessary, the next step is to find a qualified surgeon who accepts Medicare insurance. You can search online for surgeons in your area or ask your doctor for a recommendation. It’s also important to do some research on the surgeon’s qualifications and experience to make sure they are qualified to perform the procedure safely.

Steps to take if you are considering bariatric surgery and have Medicare insurance

If you are considering bariatric surgery and have Medicare insurance, it’s important to take the following steps:
  1. Consult with your doctor or healthcare provider to determine if you meet the medical criteria for the procedure.
  2. Research qualified surgeons in your area who accept Medicare insurance.
  3. Ask questions about the surgeon’s qualifications and the risks associated with the procedure.
  4. Discuss any additional costs that may not be covered by Medicare.
  5. Make an informed decision about whether or not to proceed with the surgery.
Ultimately, it’s important to work closely with your doctor throughout the process in order to make an informed decision.

Takeaway

If you are severely obese and have been unable to lose weight through diet and exercise, bariatric surgery may be an effective solution for you. However, before proceeding with any type of surgery, ensure you understand all the risks and speak with your doctor. This content is for informational purposes only. For all your Medicare questions, call an expert at Fair Square Medicare.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2024 Help Button Inc

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