Medicare coverage for bariatric weight loss surgery is available for individuals eligible due to morbid obesity. When it comes to fighting obesity, weight-loss surgery is known as one of the most efficient approaches.
Today, nearly 40% of US adults are obese, an estimate from the Centers for Disease Control and Prevention.
Obesity increases many pressing health risks; that may significantly decrease a person’s quality of life and shorten their lifespan.
Does Medicare Cover Bariatric Weight Loss Surgery
As the obesity issue grows, so does the demand for Medicare coverage for bariatric weight loss surgery. Although Medicare only considers approval for bariatric surgery procedures that are approved by the FDA.
Qualifications include having a body mass index (BMI) of 35 or higher with at least one relating health condition. (high blood pressure, diabetes, high cholesterol, to name a few)
The FDA also requires medical documentation or health records stating a patient battled obesity during the past five years.
Although Medicare pays for some bariatric procedures, the program decides denial or approval of benefits on a case-by-case premise.
As we know, not all life situations are the same; therefore, coverage may vary from person to person. However, because so many conditions stem from morbid obesity – surgery is often medically necessary.
Medicare includes different types of bariatric weight loss surgery needed to treat obesity or related health conditions. Gastric Bypass surgery is one of the oldest weight loss procedures that the program covers in the US.
Unfortunately, obesity has become a national epidemic. At the rate we’re going – by the year 2030, about half American adults will be obese.
Nutrition expert Dr. Lawrence spoke on the issue, “it’s alarming”, he went on “we’re going to have some pretty awful problems; medically and financially because so many people weigh too much.”
How Long Does it Take Medicare to Approve Bariatric Surgery
On average, it may take 3-4 months for Medicare to approve bariatric surgery. However, this timeframe may vary depending on health conditions and severity.
Medicare Requirements for Bariatric Surgery
The approval process begins after meeting the FDA standards. Medicare requirements are comparable to most major insurance provider conditions. Including a referral from your doctor stating the medical necessity for surgery.
Before approval, you must have records that prove you tried at least one medically supervised weight loss program.
Throughout the duration, you must fully engage and actively strive to lose weight within the program. You must also show proof you tried and failed (at least one) supervised weight loss program – typically provided by your doctor.
Other Medicare requirements for bariatric surgery include blood testing (Thyroid, Adrenal, and Pituitary); and a psychological evaluation.
Medicare Comorbidities for Bariatric Surgery
Comorbidities are health conditions that relate to another health problem. Sometimes, this means one health issue caused another problem.
Medicare comorbidities for bariatric surgery may include type 2 diabetes, sleep apnea, hypertension, joint or back pain, soft tissue infections, and more.
Although, the most common condition for surgery is high cholesterol in the blood. Let’s look at Stephanie’s situation as an example.
Before bariatric surgery, she had high cholesterol. Now, she’s dropped over 100 pounds. She says, “I regained my self-confidence and took job opportunities I wouldn’t have in the past.”
Bariatric surgery gave Stephanie a better quality of life and improved her health status.
Does Medicare Cover Gastric Bypass Surgery
Yes, after an obesity screening with a BMI test and counseling Medicare may cover gastric bypass surgery. However, you must meet the criteria for morbid obesity and satisfy any deductible costs.
Part A helps cover the inpatient hospital expenses; if surgery is an outpatient procedure, Part B helps pay 80% of costs for doctor services and supplies. Part D will cover any prescription medications that your doctor prescribes after surgery.
There are still other out of pocket costs, as the remaining 20% under Part B and both the Part A and B deductible. A Medicare Supplement plan would cover most, if not all, of this expense.
Does Medicare Cover Gastric Sleeve Surgery
Medicare does cover gastric sleeve surgery when available in your service area. The level of coverage also depends on whether you’re getting care as an inpatient or outpatient.
Gastric sleeve surgery removes and separates about 85% of the stomach, and then the remaining gets molded into a tubular shape that can’t contain much food or liquid.
Patients lose an average of 65% of extra weight after gastric sleeve surgery, which may be why it was the fastest-growing bariatric surgery in 2019.
Does Medicare Cover Duodenal Switch Surgery
The Duodenal Switch is one of the newer surgery options available under Medicare coverage. Like the gastric sleeve option – DS removes 70% of the stomach rather than 85%.
Medicare covers Duodenal Switch, although surgeons are not as familiar with this surgery, which makes it more challenging to find the right doctor to perform your procedure.
Does Medicare Cover Lap Band Surgery
Yes, Medicare covers lap band surgeries. The cost of benefits varies depending on several factors. Talk to your doctor and ask how much surgery may cost to plan for out-of-pocket expenses.
How Much Does Lap Band Surgery Cost
Lap band surgery costs vary, but the average price is $15,000 in the US. Although that price is subject to increase up to $30,000. As with any surgery, complications are always a risk. Lap band removal costs are at least if not more than that amount.
Does Medicare Cover Weight Loss Revision Surgery
Yes. Previous weight loss surgery may fail, and you may need a revision. Requesting a weight loss revision surgery may initiate many questions at first.
Make sure to be open and transparent with your doctor to ensure you both agree with your condition. After your doctor recommends surgery, Medicare pays for weight loss revision surgery when it’s medically necessary.
Will a Medicare Advantage Plan Cover Weight Loss Surgery
Coverage for any procedure with a Medicare Advantage plan can change depending on a range of circumstances.
UnitedHealthcare has an Advantage plan that covers weight loss surgery after meeting the plan’s guidelines.
Advantage plans determine the level of benefits and costs of service based on the service area, health condition, and medical necessity.
Medicare Advantage beneficiaries should contact their policy directly if unsure about coverage and benefits.
Will a Medigap Policy Cover Weight Loss Surgery
Original Medicare, often combined with Medigap, helps to cover out-of-pocket charges that come with weight loss surgery.
Whether it be overnight stays in a hospital after your procedure or the number of follow-up visits with your doctor – medical bills quickly add up and can easily become unaffordable.
If Medicare covers it, OF COURSE Medigap covers it too! Supplement insurance helps fill in the gaps for costs Medicare doesn’t pay, such as copayments, deductibles, and coinsurances.
Medicare pays for 80% of your healthcare costs, which leaves the beneficiary with a bill for the remaining 20%. Depending on how much a procedure or healthcare service costs, 20% may still be an expensive bill.
We’re Here to Help!
At MedicareFAQ, we understand how seniors living on a fixed income may feel bariatric surgery is financially out of the question. Don’t lose hope just yet; you still have options to explore!
We can help find a supplement plan tailored to your healthcare needs. Just give us a call at the number and talk to one of our licensed agents today, get the answers you’re looking for with no commitment to purchase.
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