Recipients with Medicare Parts A & B should check with Medicare to see if they have Medicare coverage for lap band surgery. There’s a range of options for surgical weight loss. Those with Medicare Advantage plans need to check with their specific provider.
Medicare Coverage for Lap Band Surgery
Lap band surgery can cost between $8,700 and $29,000, depending on your location and your surgeon. The average cost in the United States is $14,452.
Check with the surgeon who will be performing the surgery to determine how much of a co-payment will be owed after Medicare pays their share. A Medigap plan can help to make up the difference between what is covered by Traditional Medicare Parts A & B.
How to Know If You Are a Candidate for Lap Band Surgery
To be considered for this treatment by Medicare, these are the guidelines:
- A patient’s BMI must be 35 or above
- Other comorbidities should also be present, such as sleep apnea or acid reflux
- The patient must show that other weight loss treatments have failed to work
- There must be a medical history of obesity for at least five years
- Tests for adrenal, thyroid and pituitary problems have been done and found negative
- A letter from the patient’s primary physician recommending this procedure, including a psychological evaluation
Obesity is a National Health Concern
Nearly 40% of the American population is considered to be obese. That equates to a little over 93 million Americans. Hispanics and African Americans have a 47% rate of obesity, higher than any other ethnic groups.
Lower-income Americans have a higher rate of obesity than upper-income Americans, and middle-aged Americans (40-59) are more likely to be obese than those younger and older than they are.
Obesity is a result of more substantial portions, more processed foods, an overload of sugar and other issues in the typical American diet. Also, 80% of Americans don’t exercise enough, according to government recommendations.
Obesity is a factor in some of the leading causes of death, including cancer, type II diabetes, stroke, and heart disease. Costs for those who are obese for medical care are nearly $1500 a year more than for those who are of average weight.
Lap Band Surgery – How it Works
Lap band surgery, or laparoscopic adjustable gastric banding, is a procedure in which obese patients have a band placed around their stomach laparoscopically.
This band can be adjusted based on the patient’s needs. The goal is for the lap band to make the stomach smaller, reducing both appetite and the ability to take in food.
The average long-term weight loss for lap band patients is good, with an average of 40% of excess weight loss in the first year. Most patients will lose 70% of their excess weight long term.
Those who are not successful at losing weight generally are not following the dietary guidelines and recommended exercise plans.
For lap band surgery to work, patients must revamp their lifestyles and closely monitor their food consumption and activity levels. It takes a significant commitment and diligence to see changes.
While complication rates are low, some problems can occur:
- Infections at the surgical site
- Band slipping
- Excessive bleeding which can damage the esophagus or the liver
Lap band patients require consistent follow-up and monitoring to adjust the saline levels in their lap bands, which are typically changed within the first few weeks of surgery and then later on.
A lap band, unless complications arise, stays in the body for life, so deciding to get one requires careful consideration.
Get Help Paying Your Out Of Pocket Costs for Lap Band Surgery & Other Medicare Expenses
If you’re a Medicare recipient in need of surgical weight loss, but are concerned with the out of pocket costs regarding Medicare coverage for lap band surgery, we can help.
Our agents can help you find a Medicare Supplement plan to help pay for the costs you’re left to pay after Medicare pays their portion. Give us a call, or complete our online rate form to compare prices and plans in your area now.