Friday February 23, 2024
Does Medicare Cover Weight-Loss Treatments?
Traditional Medicare covers some weight-loss treatments such as counseling and certain types of surgery for beneficiaries. Unfortunately, Medicare does not cover weight-loss programs or medications. Here is what you should know.
Who is Eligible?
To be eligible for Medicare-covered weight-loss treatments, the patient's body mass index (BMI), which is an estimate of body fat based on the height and individual's weight, must be 30 or higher.
A BMI of 30 or more increases the risk for many health conditions such as certain cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea. To calculate BMI, the National Institutes of Health has a free calculator accessible online at nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.
What is Covered?
For individuals with a BMI of 30 or higher, Medicare Part B will cover up to 12 months of weight-loss counseling conducted by a medical professional in a primary care setting such as a doctor's office. Most counseling sessions entail an initial screening, a dietary assessment and behavioral therapy designed to help you lose weight by focusing on diet and exercise.
Medicare also covers bariatric and metabolic surgery for beneficiaries who have a BMI of 35 or above who also have at least one underlying health condition, such as diabetes or heart disease. To be eligible, a patient must also demonstrate prior efforts to lose weight through dieting or exercise but were unsuccessful. These procedures involve making alterations to the digestive system to help lose weight and improve metabolic health.
One common bariatric surgical procedure covered by Medicare is Roux-en-Y gastric bypass surgery, which reduces the stomach to a small pouch that induces the feeling of fullness even after eating small meals. Another procedure that may be covered is called a laparoscopic adjustable gastric banding, which inserts an inflatable band that creates a gastric pouch encircling the top of the stomach similarly inducing a feeling of fullness.
What is Not Covered?
Medicare does not cover weight-loss programs such as fitness or gym memberships, meal delivery services or weight-loss programs. Additionally, Medicare does not cover any weight-loss medications, but it does cover FDA-approved medications to treat diabetes, which, in some cases, have been found to help with weight loss.
Medicare Part D covers Ozempic and Mounjaro for diabetes only, not for weight loss. Medicare also does not cover Wegovy or Zepbound because they are approved only for weight loss.
Do not start a weight loss prescription without first consulting your primary care physician to determine the benefits and potential risks. Without insurance, weight-loss medications are expensive, often costing $1,000 to $1,300 per month. To help curb costs, try reputable prescription discount websites or, if your income is limited, try patient assistance programs through pharmaceutical companies.
Individuals who are enrolled in a private Medicare Advantage plan, may have coverage for gym memberships and some weight loss and healthy food delivery programs. These are considered expanded supplemental benefits and have gradually been added to some plans to provide coverage for nutrition, health and wellness. Contact your plan provider to see what is covered.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.