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Does Medicare cover bariatric surgery and weight loss?

"Does Medicare Cover Bariatric Surgery and weight loss?"

Just the Essentials…

  • Maintaining a healthy weight is one of the most important factors when it comes to aging gracefully. Excessive weight can often lead to health complications, which can shorten your lifespan and negatively impact your quality of life.

  • Sometimes, weight loss surgery (a.k.a. bariatric surgery) can be medically necessary as an emergency procedure. Original Medicare will cover some forms of bariatric surgery, as long as certain conditions are met.

  • For more comprehensive coverage for weight loss and weight loss surgeries, you can try looking into Medicare Advantage plans, which offer the same coverage as Original Medicare plans plus additional benefits.

The Importance of Maintaining a Healthy Weight for Seniors

As almost everyone is aware, getting older can often cause our bodies to weaken in many ways, increasing our risk of developing certain diseases and disabilities. One of the most important factors to consider when attempting to stay as healthy and fit as possible as you live out your golden years is your weight.

Being significantly overweight as a senior can dramatically increase your risk of conditions like heart disease, stroke, high blood pressure, diabetic complications, respiratory issues, arthritis, and more. For this reason, doctors and other medical professionals continue to stress the importance of maintaining a healthy weight for older individuals.

What is bariatric surgery?

Bariatric surgery is sort of an umbrella term that refers to weight loss surgeries such as gastric bypass and gastric sleeve surgery. These operations typically involve making physical changes to your digestive system in order to help you lose weight. Some procedures limit how much you are physically able to eat, while others work by reducing the body’s ability to absorb nutrients. In fact, some procedures actively do both.

While this type of surgery can offer many benefits, they can also pose serious risks and side effects. For this reason, bariatric surgery is primarily used as a last-resort when diet and exercise are not an effective means of weight loss due to serious health problems, excessive frailty, or similar reasons.

Weight loss surgery also requires you to make permanent, healthy changes to your diet and get plenty of exercise in order to help ensure long-term success. As such, it is not a replacement for living a healthier lifestyle. 

Additionally, bariatric surgery is not recommended for everyone who is overweight. Often, qualifying for bariatric surgery requires you to meet certain medical guidelines via an extensive screening process. In general, bariatric surgery may be an option for you if you meet the following criteria:

  • You have a Body Mass Index (BMI) of 40 or more (extreme obesity)
  • You have a BMI of 35 – 39.9 (obesity) coupled with a serious weight-related health problem such as type 2 diabetes, high blood pressure, or severe sleep apnea.
  • You have a BMI of 30 – 34 as a direct result of a weight-related health problem.

Keep in mind that bariatric surgery can be incredibly expensive, leaving many seniors to ask, “does Medicare cover bariatric surgery?” As always, the answer to this question can be quite multifaceted.

Does Medicare cover bariatric surgery?

You may be pleased to learn that Original Medicare Parts A and B do cover some bariatric surgeries, including gastric bypass and laparoscopic banding surgery, as long as you meet specific conditions related to morbid obesity.

When it comes to determining your exact costs of bariatric surgery under Original Medicare, it can be difficult to know in advance. If weight loss surgery has been declared medically-necessary by your doctor, you may be able to get a ballpark figure of your out-of-pocket costs by doing the following:

  • Asking your doctor, hospital, or long-term care facility how much you’ll have to pay for the surgery and the aftercare that comes with recovery.
  • Researching the choice between an ambulatory surgical center and a hospital outpatient department
  • Learning whether you are considered an inpatient or an outpatient (costs can differ dramatically between the two)
  • Checking with your Medicare insurance company to learn what costs it will pay. You can typically do this by phone, or online by logging into (or creating) your secure Medicare account and reviewing your Medicare Summary Notice (MSN)
  • Exploring more comprehensive coverage options under Medicare Advantage that may better suit your health insurance needs.

How can I get more comprehensive Medicare coverage that may better suit my specific healthcare needs?

Over the course of their life, many seniors often find that Original Medicare alone is not always enough to cover all of their healthcare needs. This is where Medicare Advantage, also known as Medicare Part C, comes in.

Medicare Advantage plans are required by law to provide the same level of coverage as Original Medicare Parts A and B, but they also often include additional benefits for other healthcare needs, including weight loss surgery.

Keep in mind that Medicare Advantage plans are sold by private insurance companies, meaning their exact availability, benefits, and costs can vary. Still, taking the time to research and compare Medicare Advantage plans that may be available in your area can be a good decision in the long-term.

If you’re looking for professional assistance from licensed insurance agents and Medicare Advantage experts, don’t hesitate to contact MedicareInsurance.com today by phone at (800) 950-0608.

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