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Medicare Coverage for Bariatric Weight Loss Surgeries

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.

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 Coverage

Bariatric SurgeryThe 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. Qualifications include having a body mass index (BMI) of 35 or higher with at least one relating health condition (such as high blood pressure, diabetes, and high cholesterol).

The FDA also requires medical documentation or health records stating a patient battled obesity during the past five years. 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.

What are the 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.

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, Medigap will cover 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.

How to Get Help with Medicare Coverage for Bariatric Weight Loss Surgeries

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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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

41 thoughts on “Medicare Coverage for Bariatric Weight Loss Surgeries

  1. 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?

    1. 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.

  2. 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?

    1. 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.

  3. 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

    1. 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.

  4. 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?

      1. 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.

  5. 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?

    1. 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.

  6. Hello Lindsay,
    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?

    1. 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.

  7. 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?

    1. 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.

  8. 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.

    1. 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.

  9. 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?

    1. 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.

  10. Good Afternoon,
    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

    1. 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.

  11. Hi Lindsay,

    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?


    1. 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.

  12. Hi Nina,
    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.

    1. Hi Dorothy! The waiting period is only for those receiving SSDI, and doesn’t apply if you’re 65 or older.

      1. 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!

      2. Hi Nancy! I believe you’re thinking of the 24 months those on SSDI have to wait before they are eligible for Medicare.

  13. 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.

    1. 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.

  14. 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?

    1. 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.

  15. Hi Lindsay:
    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.
    Thank you

    1. 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!

  16. 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.

  17. 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?

    1. 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!

      1. 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

      2. 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!


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