Does Medicare Cover Obesity Behavioral Therapy?
Medicare covers obesity screenings and behavioral counseling for beneficiaries with a body mass index of 30 or more. You can receive up to 22 counseling visits within a 12-month period if you meet certain program requirements. This free preventive service is available at no cost to you.
What Is Obesity Behavioral Therapy?
According to the Centers for Disease Control and Prevention, the prevalence of obese Americans increased from 30.5 percent of the population in 1999 to 42.4 percent in 2018.
Obesity is associated with many chronic conditions, including cardiovascular disease, musculoskeletal conditions and diabetes.
Obesity behavioral therapy is a preventive service that allows your doctor to discuss your weight with you, advise you on diet and exercise, monitor your progress and provide support during regular visits.
Findings from several randomized studies — including the Diabetes Prevention Program — show that regular and frequent obesity counseling visits can help people lose weight and change long-term behavior.
- Screening for obesity using a body mass index, or BMI, measurement.
- A nutritional assessment of your diet.
- Behavioral counseling and therapy to promote sustained weight loss through healthy diet and exercise.
In 2011, the U.S. Centers for Medicare and Medicaid Services, or CMS, introduced Medicare coverage for obesity counseling. It utilizes intensive behavioral therapy and takes place through structured visits over a 12-month period.
Who Is Eligible for Medicare Coverage of Obesity Screenings?
Medicare covers obesity screenings and behavioral counseling for beneficiaries with a BMI of 30 or more.
Each counseling session lasts about 15 minutes. You must be competent and alert when counseling is provided.
This counseling must be provided by a primary care doctor, nurse practitioner, clinical nurse specialist or physician assistant in a primary care setting — such as a doctor’s office.
Intensive obesity counseling sessions can also be provided via telehealth services.
Dietitians, psychologists and exercise physiologists are not listed as qualified providers for this service, despite their expertise in obesity treatment.
Obesity screenings and counseling are covered by Original Medicare.
Medicare Advantage plans also cover this service for beneficiaries who qualify.
- One visit every week for the first month.
- One visit every other week for the second through sixth month.
- One visit per month for months seven through 12 if you meet a specific weight loss requirement during the first six months.
- A maximum of 22 visits per 12-month period.
At your six-month visit, you must undergo a reassessment to determine how much weight you’ve lost.
To be eligible for an additional six months of counseling visits, you need to lose at least 3 kilograms — or about 6.6 pounds — during your first six months of intensive therapy.
If you don’t reach the minimum weight loss goal, you still get another chance.
However, you will need to wait another six months before Medicare will pay for you to try again.
You can make an unlimited number of attempts, so long as your BMI is still 30 or greater and six months have passed since your last attempt.
You pay nothing for obesity screenings and behavioral therapy so long as you have a BMI of 30 or more and your qualified health care professional accepts Medicare.
This therapy is also available if you’re enrolled in a Medicare Advantage plan. But you will likely need to see a doctor inside your plan’s network to receive coverage.
Other Obesity-Related Services Covered by Medicare
- Medical Nutrition Therapy
- You can only qualify for this program if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last three years. There is no weight requirement to participate. Nutritional therapy services can include individual and/or group nutritional sessions, help managing lifestyle choices that affect your diabetes and follow-up visits to check on your diet.
- SilverSneakers and Other Fitness Programs
- SilverSneakers is a popular fitness benefit program offered by more than 60 Medicare Advantage and Medigap plans. This program can provide access to gyms, instructors and other resources for free at more than 17,000 locations across the country. You don’t need to be overweight to use this benefit. Renew Active and Silver&Fit are two other fitness programs offered by some Medicare Advantage plans. Original Medicare does not cover SilverSneakers or similar programs.
- Bariatric Surgery
- Medicare covers some bariatric surgical procedures — including gastric bypass surgery and laparoscopic banding surgery — if you meet certain criteria. This includes having a BMI of 35 or higher, having at least one underlying health condition related to obesity and being previously unsuccessful with other medical treatments for obesity. You will pay 20 percent of costs for surgery and related services. Part A and Part B deductibles also apply.
There are several weight-loss services Medicare does not cover, including weight loss programs such as Weight Watchers and FDA-approved diet pills.
While Medicare covers most bariatric surgery procedures for those who qualify, it does not cover them all, including gastric balloon surgery and intestinal bypass.
9 Cited Research Articles
- U.S. Centers for Disease Control and Prevention. (2021, February 11). Adult Obesity Facts. Retrieved from https://www.cdc.gov/obesity/data/adult.html
- Batsis, J. A., Huyck, K. L. and Bartels, S. J. (2014, September 17). Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284254/
- Centers for Medicare & Medicaid Services. (2013). National Coverage Determination (NCD) for BARIATRIC SURGERY for Treatment of Co-Morbid Conditions Related to Morbid Obesity (100.1). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=57&ncdver=5&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=All&KeyWord=Bariatric+Surgery&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAACAAAAAAAA%3D%3D
- Centers for Medicare & Medicaid Services. (2011, November). National Coverage Determination (NCD) for Intensive Behavioral Therapy for OBESITY (210.12). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=353&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=All&KeyWord=obesity&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAABAAAAAA
- Barry, P. (n.d.). Can Medicare Help Me Lose Weight? Retrieved from https://www.aarp.org/health/medicare-insurance/info-03-2012/medicare-weight-loss-counseling-99.html
- Bartholomay, L. (n.d.). Medicare’s Intensive Behavioral Therapy for Obesity. Retrieved from https://www.health.state.mn.us/facilities/hchomes/collaborative/lcdocs/webinars/medicareibtwebinar.pdf
- Medicare.gov. (n.d.). Bariatric surgery. Retrieved from https://www.medicare.gov/coverage/bariatric-surgery
- Medicare.gov. (n.d.). Nutrition therapy services. Retrieved from https://www.medicare.gov/coverage/nutrition-therapy-services
- Medicare.gov. (n.d.). Obesity behavioral therapy. Retrieved from https://www.medicare.gov/coverage/obesity-behavioral-therapy