Does Medicare Pay for Bariatric Weight Loss Surgery?
As the obesity rate in the United States rises, so does the demand for Medicare coverage of bariatric weight loss surgery. Many patients ask us frequently, will Medicare cover bariatric surgery. Medicare covers various bariatric weight loss surgeries to treat obesity and related health conditions after meeting certain requirements and receiving approval from a licensed physician.
Despite the fact that Medicare will cover weight loss surgery, the program decides on benefits denial or approval on a case-by-case basis. To be approved, weight loss surgery must be FDA-approved. Even if a Medicare beneficiary meets the requirements for bariatric surgery procedures, their doctor and Medicare have the final say on whether or not they are covered.
Not every circumstance in life is the same. Regrettably, this implies that coverage may differ from one individual to the next. However, since many diseases are caused by excessive obesity, weight loss surgery is often deemed medically necessary.
Types of Bariatric Surgeries Covered by Medicare
Although Medicare covers a variety of bariatric weight loss operations, not all of them are covered. The following is a list of weight-loss operations that Medicare covers:
- Sleeve Gastrectomy
- Gastric Bypass
- Duodenal Switch
- Laparoscopic Adjustable Gastric Banding Surgery
Roux en y gastric bypass is a surgical surgery that divides the stomach into tiny sections in order to reduce calorie intake. Medicare may reimburse gastric bypass surgery after an obesity screening, including a BMI test and counseling. You must, however, fulfill the morbid obesity standards and pay any deductible charges.
When your doctor deems it medically necessary and you meet the bariatric requirements, Medicare will cover sleeve gastrectomy surgery.
This treatment, also known as gastric sleeve surgery, involves removing and separating around 85 percent of the stomach. The remaining is then shaped into a tubular form that can only hold a little amount of food or fluids.
After gastric sleeve surgery, patients lose an average of 65 percent of their excess weight, which may explain why it is one of the most popular bariatric procedures.
The duodenal switch is a relatively recent operation that is covered by Medicare. DS eliminates a major section of the stomach, similar to the gastric sleeve procedure.
Duodenal switch surgery is covered by Medicare. However, finding a bariatric surgeon to do the treatment might be difficult. Because many surgeons are unfamiliar with this procedure, finding the correct practitioner might be difficult.
Medicare’s Bariatric Surgery Coverage Requirements:
- Obesity is linked to one or more medical conditions.
- Obesity medical records dating back more than five years, as well as a letter of reference from a physician
- Obesity-causing medical diseases have been ruled out.
- A BMI (body mass index) of 35 or greater
- Participation in a medically supervised weight reduction program with documentation
- Passed psychological evaluation
You must fulfill all of the above criteria to be considered a candidate for bariatric weight reduction surgery. Medicare is not required to approve your operation even if you fulfill all of the requirements. Each permission is given on an individual basis.
How Long Does it Take Medicare to Approve Bariatric Surgery Take?
Approval of bariatric surgical procedures by Medicare may be a complex process. Medicare may take three to four months to authorize the procedure from the initial visit to medical clearance.
Medicare Comorbidities for Bariatric Surgery
Comorbidities are disorders that are linked to another health problem. This may sometimes imply that one health concern leads to another. Comorbidity refers to any ailment that arises as a direct consequence of morbid obesity in the context of bariatric surgery. Type 2 diabetes, sleep apnea, hypertension, joint or back pain, soft tissue infections, and other comorbidities are listed by Medicare as major bariatric surgery-approved comorbidities.
If you are morbidly obese but do not have any of the following illnesses, you may still be a candidate for weight loss procedures. You must, however, show that the comorbidity is linked to obesity.
Average Cost of Bariatric Surgery With Medicare
The typical cost of bariatric weight loss surgery in the United States is between $25,000 and $30,000. With Medicare Part A and Part B, those who meet the eligibility requirements and are accepted for coverage will be responsible for the Medicare Part A and Part B deductibles, Medicare Part B 20% coinsurance, and any coinsurance or deductible payments for Medicare Part D.
Inpatient hospital charges are covered by Medicare Part A. If your operation is an outpatient procedure, however, Medicare Part B will cover 80% of your doctor’s services and materials. Then, following your operation, Medicare Part D will pay for any prescriptions that your doctor recommends.
After original Medicare pays, a Medicare Supplement insurance would cover most, if not all, of your out-of-pocket payments. If you have Medicare Advantage coverage, on the other hand, you may have to go through more extensive prerequisites. This is because your coverage will change from that of Original Medicare.