According to the Centers for Disease Control and Prevention (CDC), nearly 40% of US adults are obese. Obesity increases the chance of major health risks and may significantly decrease a person’s quality of life. Thus, shortening the lifespan. When fighting obesity, weight loss surgery – such as bariatric surgery – is one of the most efficient approaches.
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If you are a Medicare beneficiary hoping to receive bariatric surgery, you could receive coverage through your Medicare plan. Medicare coverage for bariatric weight loss surgery is available for beneficiaries who meet specific criteria. While not all bariatric weight loss surgeries receive coverage, several options are available for those with Medicare.
Does Medicare Cover Bariatric Weight Loss Surgery?
The demand for Medicare coverage of bariatric weight loss surgery is steadily growing as the obesity rate of Americans is on the rise. After meeting various requirements and gaining approval from a licensed physician, Medicare coverage includes different bariatric weight loss surgeries to treat obesity and related health conditions.
Although Medicare pays for bariatric procedures, the program decides denial or approval of benefits on a case-by-case basis. To be considered for approval, the bariatric surgery must first be approved by the FDA. However, even after a Medicare beneficiary meets the requirements for bariatric surgery, Medicare coverage is still at the discretion of their doctor and Medicare.
Not all situations in life are the same. Unfortunately, this means coverage may vary from person to person. However, bariatric surgery is often deemed medically necessary because many conditions stem from morbid obesity.
Types of Bariatric Weight Loss Surgeries Covered By Medicare
Although Medicare covers several bariatric weight loss surgeries, it doen’t cover all surgery types. Following is a list of weight-loss surgeries that receive coverage from Medicare:
- Gastric Bypass
- Sleeve Gastrectomy
- Duodenal Switch
- Lap-Band Surgery
Outside of this list of procedures, Medicare coverage for weight loss surgery is limited and may not be available.
Gastric Bypass is a medical procedure that splits the stomach into small portions to restrict caloric intake. 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.
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Medicare covers sleeve gastrectomy surgery when your doctor deems it medically necessary and you meet the bariatric requirements.
More commonly known as gastric sleeve surgery, this procedure removes and separates about 85% of the stomach. Then, the remainder 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 is one of the fastest-growing bariatric surgeries.
The duodenal switch is a newer surgery option available with Medicare coverage. Like the gastric sleeve option, DS removes a large portion of the stomach.
Medicare covers duodenal switch surgery, although it may be challenging to find a surgeon who will perform the procedure. Many surgeons are not as familiar with this surgery, making it more challenging to find the right doctor.
Lap-Band surgery is a type of gastric bypass that splits your stomach into an upper and lower section. Under the right conditions, Medicare will cover lap band surgeries. The cost varies depending on several factors. Talk to your doctor and ask how much surgery may cost so you can plan for out-of-pocket expenses.
Medicare Requirements for Bariatric Surgery Coverage
- One or more obesity-related health condition
- Medical documents of obesity for more than five years and letter of recommendation from physician
- Ruled out medical disease-causing obesity
- BMI of 35 or greater
- Documented participation in medically supervised weight loss program
- Passed a psychological exam
To be considered a candidate for bariatric weight loss surgery, you must meet all the above requirements. Even if you meet each requirement, Medicare is not required to approve your surgery. Each approval is on a case-by-case basis.
How Long Does It Take Medicare to Approve Bariatric Surgery?
Bariatric weight loss surgery approval by Medicare can be a complicated process. From the first appointment to medical clearance, Medicare may take three to four months to approve the surgery. However, this timeframe may vary depending on health conditions and severity.
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Medicare Comorbidities for Bariatric Surgery
Comorbidities are health conditions that relate to another health problem. Sometimes, this means one health issue causes another problem. In the case of bariatric surgery, comorbidities refer to any condition derived as a direct result of morbid obesity. Medicare lists major bariatric surgery approved comorbidities as: type 2 diabetes, sleep apnea, hypertension, joint or back pain, soft tissue infections, and more.
If you are morbidly obese and are not experiencing any of the diagnoses above, you may still qualify for bariatric surgery. However, you must prove comorbidity due to obesity.
Average Cost of Bariatric Weight Loss Surgery With Medicare
In the United States, the average cost of bariatric weight loss surgery can be as much as $25,000-$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.
Medicare Part A helps cover the inpatient hospital expenses. However, if your surgery is an outpatient procedure, Medicare Part B helps pay 80% of doctor services and supplies. Then, Medicare Part D will cover any prescription medications that your doctor prescribes after surgery.
A Medicare Supplement plan would cover most, if not all, of your out-of-pocket expenses after Original Medicare pays. On the other hand, if you receive coverage from a Medicare Advantage plan, you may need to go through more extensive pre-requisites. This is because your coverage will differ from Original Medicare.
How to Get Help with Medicare Coverage for Bariatric Weight Loss Surgeries
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- Adult Obesity Facts, CDC. Accessed February 2022.
- Bariatric Surgery, Medicare. Accessed February 2022.
- Definition and Facts of Weight-Loss Surgery, NIDDK. Accessed February 2022.
47 thoughts on “Medicare Coverage for Bariatric Weight Loss Surgeries”
I meet the requirement for BMI and also take medication for hypertension and depression. I am on SSDI and will be on Medicare beginning 9/1/2022. I have tried every diet imaginable, was able to lose 70 pounds in order to have my two hip replacement surgeries in the last 2 years but have been unable to lose any more weight. I am unable to walk long distances and stand or sit for long periods of time and have a compressed disc in my lower back. My dr. has discussed the bariatric surgery with me – am I a candidate and will my MedicareAdvantage plan cover the surgery?
Hi Patricia, It sounds like you meet some of the requirements for surgery. However, only your doctor will be able to make the determination of whether or not you are a good candidate for surgery. If it is deemed medically necessary and you meet Medicare’s requirements, your surgery should be covered by your Medicare Advantage plan.
I need gastric bypass revision surgery. It has been 20+ years since my gastric bypass. In the past 10 years I have regained an amount that is resulting in my having type 2 diabetes (weight related), high blood pressure (weight related), horrible acid reflux! The Dr. has told me the stomach has not enlarged but, the Stoma has stretched over time therefore not restricting anything I eat staying in my stomach. The Gastroenterologist specialist I am seeing tells me this can be corrected by suturing up the opening, therefore resulting in dropping the weight regain. And getting my health back. I have Medicare A B D and N which is a supplemental in’s that pays everything Medicare doe# not. Canthisbe aporoved?
Hi Pamela. This procedure can be approved by Medicare if your doctor deems it medically necessary. Additionally, you will need to meet all requirements set my Medicare to approve a bariatric surgery.
I am 68 yrs old- My BMI is 52.4 I have Medicare A & B- I have Sleep apnea, Osteoarthritis in both knees, have Afib, Just got put on another medication for heart, have several inhailers -pre diabetic, and I looking at the Lap band surgery.
Would Medicare help pay for part of the procedure?
It seems you meet several of the requirements Medicare required to cover weight loss surgery. However, there are several other requirements that would require your doctor to sign off on. The first step is speaking with your physician and finding the best treatment options, from there if you meet all guidelines required by Medicare, they should typically provide coverage.
I completed medicare’s 4 months of nutrition care as well as sign off by all physicians but waited 3 months after the last nutritionist appointment to schedule sleeve surgery. I was told by the scheduler that I would need to start the 4 months of nutritional care over again because of the delay. Is that medicare’s policy?
Jack, Medicare does require that you complete 4 months of nutrition care, however, surgery scheduling time is at your doctor’s recommendation. This could be a policy your doctor has put in place.
I have read a lot of the FAQs. I called Medicare but was unable to have my question answered. I had lapband surgery 17 years ago. It has not been successful for me. After several tests this past October, it was found that I now have a slipped lapband and a large volume gastroesophageal reflux. I need to have the lapband removed and the reflux repaired. I would like a revision to a gastric bypass at the time the lapband is removed. I meet all the qualifications for a gastric bypass that Medicare requires except a recent medically supervised weight loss program for 4 months. If it is medically necessary to remove the lapband and get a revision, would Medicare waive the medically supervised weight loss program? I don’t know if I can wait the 4 months as this reflux causes me a severe chest pain, heart burn, and wakes me up at night with coughing due to acid in my airway. The two Medicare agents I spoke to couldn’t help me at all since they only had the basic information that I can find on the internet. If I have to complete the last requirement I will try to hang in there. I sure don’t want two separate surgeries. Where do you suggest I go from here?
Jolynn, I am glad you find our page useful! Typically, Medicare would not waive the four-month weight loss program, however, this is a special circumstance that you would need to speak about with your doctor and Medicare Prior Authorization specialist.
I just had total knee replacement surgeries on both knees and I have chronic kidney disease stage 3b I have high blood pressure I’m diabetic and I have depression and high cholesterol I have Medicare my BMI is 42 I’ve tried other diets and still being over weight I’m still in a lot of pain will Medicare cover to get gastric bypass my dr is giving me a referral to a dr for it
Hi Teresa – it sounds like you are a candidate for weight loss because your BMI qualifies you. As long as at least one of your conditions is due to your weight – which diabetes, high cholesterol, and high blood pressure likely are at least exacerbated by it – you will qualify.
Hi I’m 25 years old with a BMI of 35.8. I am try to get coverage and have Medicaid. Mainly because I have severe back pain and bad pain in my feet and can barely walk without pain. Also have chest pain. Does Medicaid cover for that with that BMI?
I also have 2 kids under the age of 2 and can barely keep up with them
Hi Destiney, this is a Medicare learning resource site. However, the details of Medicaid depend upon the state where you live. With your BMI, you will likely also need to have a documented condition that is weight-related to qualify for bariatric surgery. These conditions include high blood pressure and diabetes.
My husband is trying to get the D.S. Weight loss surgery. He has done all the required things the Dr. said he had to do in order for Medicare to pay. We have been waiting for a long time and when I called to check on where we were in the process they told me that there were some changes in Medicare and that if a person gets the surgery they can’t see a Dr. for 90 days and they said that is a problem because they will have to see him 3 times in that 90 days. I said that doesn’t even make sense every surgery requires to follow up. Can you give me some insight on this because I don’t think they know what they are saying?
Hi Brandie! A lot of representatives that work for Medicare are not educated on all aspects. Your best option is to get both your doctor and a representative with Medicare on the phone at the same time to discuss your treatment plan and options. Otherwise, you will keep going back and forth with no solution.
I work in a surgeon’s office and I was wondering if you can clarify something for me as I am not able to find specific criteria. We have a few patients who have had bariatric surgery previously and would like another (band to sleeve, sleeve to bypass) due to them gaining all or some weight back years later. We were previously told the patient needed to have all previous documents from original surgery showing they were successful in their previous attempt along with current records from our office for revision, then we could submit to Medicare. I read recently in the LCD that Medicare potentially covers for repeat bariatric surgery when “clinical circumstances demonstrate reasonability and necessity (such as replacing a defective device or correcting a complication in a patient who had met medical necessity for the original procedure and has achieved acceptable weight loss)”. We have patients who had achieved acceptable medical weight loss, but then years later gained some or all back. Does Medicare not cover repeat surgery unless they have a complication? Do they need previous records from first surgery?
Hi Sarah! This is a little bit out of my expertise but if I were to guess, I would say it really depends on how you present the case to Medicare. If you have good supporting documentation and a treatment plan in place, I believe Medicare would approve a second surgery without having actual complications from the first one. It’s one of those scenarios where one client may get denied, but another may get approved because you presented it differently.
Does Medicare cover the cost of skin removal after extreme weight loss from gastric sleeve surgery? I’m covered under Medicare and have 2 separate policy’s from AETNA (my husband’s employer and mine were different but used AETNA as their provider)
Also, does Medicare cover bariatric surgery in Mexico?
Hi Jolene! As long as your primary care physician says the skin removal surgery is medically necessary, Medicare will cover it. No, Medicare will not cover any procedures done outside the United States.
Hello, my weight is 230, I am 5’3. I take a blood thinner for AFib, 2 blood pressure meds, and water pill, I am 67 years old. I have been over weight all my life and have tried several weight loss programs and always loss some weight and gained it back. Would I have to wait the 3-4 months for surgery. I am on Medicare.
Hi Debra! It depends on your health condition and severity. Your doctor and you should call Medicare directly together to discuss your options and what ways you could speed up the approval process.
I had the sleeve procedure done about 6 years ago, my gastroenterologist said I have gastroparesis and Gerd. My surgeon said I need bypass to cure the problem. Will I have to wait 3 months for approval?
Hi Roxanne! It really depends on your specific situation. Yes, you could wait 3 months for approval. However, your doctor may be able to fast-track it. I would call Medicare directly with your provider to figure out exactly what you need and what options you have to get the surgery approved faster.
I am on medicare now. 15 years ago i had lap band surgery and 3 years ago had to have it removed because of stomach issues. At that time i was on insurance thru my job. I have gained back weight and want to have gastric bypass. I contacted one dr locally and they said Medicare would not cover it because it would be a revision. I now weigh 300lbs . i have gained about 80 pounds since i had my lap band removed. I want to check to see if medicare will pay for my gastric bypass
Hi Jan! If it was considered medically necessary to remove your lab band, and is now considered medically necessary to do it again, then Medicare should cover it. It really depends on the treatment plan your doctor puts into place and that they deem it medically necessary. I would contact Medicare directly with your doctor. They will let you and your doctor know what documents are needed to get the surgery covered.
I’m on SSDI currently, I have a BMI of 48 and have been diagnosed and currently being treated/monitoring for psuedotumor cerebri. One program has stated that I needed to be on the medication for approval as medically necessary. Is this correct? Or just being diagnosed is enough? Would I also need a letter of recommendation from my primary or specialist for this?
Hi Sarah! You would need to communicate directly between your doctor and Medicare to find out exactly what they require since it’s a case-by-case scenario.
I have Medicare A & B and Champ Va as 2nd supplement. I have High Blood Pressure/High Cholesterol and sleep apnea. Do I still require a waiting period to get approved for weight loss surgery. My BMI is 36.
Hi Dorothy! The waiting period is only for those receiving SSDI, and doesn’t apply if you’re 65 or older.
Hi Lindsay Engle,
While scrolling through the comments, I see that you mentioned a waiting period that is only for those receiving SSDI. Can you go into more detail about that please? Is there a waiting period for surgery if a person is on SSDI? Any information you can provide is greatly appreciated. I tried googling, but didn’t find any information about this. Thank you!
Hi Nancy! I believe you’re thinking of the 24 months those on SSDI have to wait before they are eligible for Medicare.
my son is 25 and autistic. his weight is 350 lbs. He has some ruptured disc, also high blood pressure, sleep apnia. he also takes zolof for depression and meltdowns. At his age would he be elgiable? He gets social security disability for the autism. He is in college.
Hi Pam! As long as your son has been collecting SSDI for at least 24 months, he would be eligible for Medicare. If his doctors find weight loss surgery medically necessary, then Medicare will cover it.
I had Gastric Sleeve surgery 6 years ago, , I’ve gained 30 pounds, and BMI is 40. Will Medicare pay for a second weight loss procedure?
Hi Brook! This is something handled on a case-by-case basis. Yes, Medicare could cover a second surgery. Make sure your doctor knows what documentation Medicare needs to get the procedure approved again.
I’m going to get Medicare benefits after June 29 this year. I need some orientation about what Medicare covers the gastric bypass, I really appreciate your response.
Hi Ivelisse! Do you have any specific questions that the article did not answer? You can always give us a call to speak directly to a licensed agent that can go over specifics on gastric bypass and Medicare coverage!
I am even more confused now than before- just earlier today I read an article on what Medicare covers and it said it only covers the lap band and the gastric bypass. It said it DOES NOT cover the sleeve. I am only 8 days away from my surgery date and am afraid to go ahead with it when I am unsure it will be covered by Medicare.
Hi Janet! As long as you meet the requirements here, Laparoscopic Adjustable Gastric Band and Gastric Sleeve will be covered.
My mom qualifies for the gastric sleeve, but is expected to pay for the nutritionist visits. She currently sees a dietician for diabetes management and these visits are covered. Why wouldn’t the nutritionist visits be covered in order for her to have the gastric sleeve procedure?
Hi Holly! This is a great question! I would think it all comes down to what’s considered “medically necessary.” If the doctor says the nutritionist visits are medically necessary for the gastric sleeve surgery, I would think Medicare should cover it. As you stated above, it’s the same scenario as diabetes management with the dietician. What I would suggest is calling Medicare directly and speak to them. They may be able to offer some guidance, it could be as simple as your doctor putting in the right CPT codes that will tell Medicare it’s medically necessary and they will cover it. I hope this helps!
I want to apply for the weight loss surgery I have medicare and Medicaid how would I go by doing this
Hi Niesha! You would need to follow the steps listed on Medicare.gov.
I have traditional Medicare A,B, & D with Medicaid as my secondary. My BMI is 48. I’m diabetic with hypertension, obstructive sleep apnea (CPAP), hyperlipidemia, & more. I had a failed 6 month medically monitored diet from 8/19-2/20. Will I be required to do another 6 month diet monitoring with Medicare? How long is the approval process? Thanks! Nina
Hi Nina! Most of the time, you only need to show proof you tried and failed once. It will depend on the documentation your doctor provides. Most approval processes are complete within 60 days. I hope this helps!