Does Medicare Cover Bariatric Surgery?

Bariatric surgery refers to any of several procedures that remove or restrict part of your stomach to prevent food absorption and promote weight loss. If you have serious comorbidities related to obesity, Medicare provides coverage for your bariatric surgery.

Lindsey Crossmier, writer for RetireGuide
  • Written by
    Lindsey Crossmier

    Lindsey Crossmier

    Financial Writer

    Lindsey Crossmier is an accomplished writer with experience working for The Florida Review and Bookstar PR. As a financial writer, she covers Medicare, life insurance and dental insurance topics for RetireGuide. Research-based data drives her work.

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    Lamia Chowdhury
    Lamia Chowdhury, editor for RetireGuide.com

    Lamia Chowdhury

    Financial Editor

    Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.

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    Christian Worstell
    Christian Worstell, Medicare expert

    Christian Worstell

    Medicare Expert

    Christian Worstell is a licensed health insurance agent and an established writer in the sector, with articles featured in Forbes, MarketWatch, WebMD and more. His work has positively impacted beneficiaries nationwide and empowers them to make strong health care decisions.

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  • Published: January 13, 2023
  • Updated: January 17, 2023
  • 6 min read time
  • This page features 4 Cited Research Articles
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A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

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APA Crossmier, L. (2023, January 17). Does Medicare Cover Bariatric Surgery? RetireGuide.com. Retrieved February 3, 2023, from https://www.retireguide.com/medicare/treatments/surgery/bariatric/

MLA Crossmier, Lindsey. "Does Medicare Cover Bariatric Surgery?" RetireGuide.com, 17 Jan 2023, https://www.retireguide.com/medicare/treatments/surgery/bariatric/.

Chicago Crossmier, Lindsey. "Does Medicare Cover Bariatric Surgery?" RetireGuide.com. Last modified January 17, 2023. https://www.retireguide.com/medicare/treatments/surgery/bariatric/.

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Is Bariatric Surgery Covered by Medicare?

Medicare covers the costs of surgeries and treatments that might be considered cosmetic in nature but are designated medically necessary. If you meet specific medical criteria, your bariatric surgery will likely qualify for Medicare coverage.

Bariatric Surgery Coverage at a Glance
Type of Medicare Plan Available coverage for surgery
Plan APart A covers inpatient procedures, including surgery and Medicare-approved costs after your Part A deductible. You are responsible for 20% of the doctor’s fees, and any coinsurance costs for hospital stays longer than 60 days
Part B Part B covers outpatient procedures, including 80% of surgeries, plus any lab tests, prescription drugs or other services received after you have reached your Part B deductible.
Part C: Medicare AdvantageThe amount of your Medicare Advantage coverage will depend on your specific plan
Part D: Prescription DrugsNo coverage
Supplemental InsuranceAny supplemental coverage can help cover costs incurred by surgery: the exact amount will depend on your plan.

Medicare Requirements for Weight Loss Surgery Coverage

You must meet specific requirements to qualify for weight loss surgery coverage.

Medicare requirements for weight loss surgeries include:
  • A BMI (body-mass-index) of 35 or more
  • At least one serious comorbidity related to your obesity
  • Documentation that you have been obese for at least five years
  • Proof that during that time you participated in at least one medically supervised weight loss programs, with no success
  • A letter from your doctor recommending surgery
  • Documentation of other tests as required (these might include blood tests, a psychological evaluation, etc.)

Comorbidities mean a serious illness or condition directly related to your obesity.

Comorbidities that qualify for bariatric surgery include:
  • Type 2 diabetes
  • Sleep apnea
  • Hypertension (high blood pressure)
  • Joint or back pain
  • Soft tissue infections
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Types of Weight Loss Surgeries Covered by Medicare

Only specific types of weight loss surgeries are covered to some extent by Medicare. Consider speaking with your doctor to make sure you are not surprised by a type of surgery not covered by your plan.

Types of Weight Loss Surgeries Covered
Gastric Bypass Surgery
A small stomach pouch is created to restrict the amount of food you can absorb. The rest of the food ‘bypasses’ your stomach through a Y-shaped section of your small intestine. This procedure is also known as the Roux-en-Y gastric bypass (RYGB).
LAP-BAND® Surgery
A hollow band filled with saline solution is placed around the upper end of your stomach, restricting the amount of food that can pass through. The amount of saline in the band can be increased or decreased, to adjust the level of restriction.
Gastric Sleeve Surgery
A significant percentage (80-85%) of your stomach is removed in this procedure, also known as a sleeve gastrectomy.
Duodenal Switch
A combination surgery, the duodenal switch both removes and reshapes your stomach to reduce capacity and bypasses food directly into your small intestine.
Revision Surgeries
Revision surgeries are those required to correct previous surgeries, or to replace implants, including filling the LAP-BAND® with saline.

Average Cost of Bariatric Surgery

The type of bariatric surgery you have, whether your procedure is inpatient or outpatient, and the result on your general health following the surgery results in varying costs. According to the National Library of Medicine, costs can range from $7,423 to $33,541.

Bariatric surgery can be expensive, so it’s important to understand how the procedure will be covered by your Medicare benefits before moving forward.

Costs include pre-operative tests and appointments, anesthesia, surgical fees, hospital stays, post-op visits and more. Medicare typically pays for 80% of fees, so your out-of-pocket expenses will include your deductible, plus 20%.

Medicare Approval Process for Bypass Surgery

Because the surgery must be deemed necessary, and you must provide proof of previous failed weight loss attempts, it can take up to four months for Medicare to approve your bariatric surgery.

You’ll have to find a Medicare-approved surgeon in your area. Your recommended physician should be able to help you with that. Once you’ve completed any required tests, your surgeon will send the results to Medicare for approval. Log into your Medicare account to check the status of your claim and approval.

Finding a Gastroenterologist Specialist In Your Network

Your primary care physician should be able to refer you to a gastroenterologist. You can also check with the American College of Gastroenterology to locate a specialist in your area or ask family and friends for a recommendation. Check with the specialist before your appointment to ensure the doctor is part of your network.

What To Expect After Bariatric Surgery

Bariatric surgery is an effective way to treat both severe obesity and the comorbidities that accompany it, and can reduce your risk of death from those factors by up to 50%. You will generally achieve 60% of your anticipated weight loss in the six months after your surgery, and up to 77% of your goal in the first year. Most patients keep at least 50% of that weight off for more than five years.

Most patients can resume normal activities between three and six weeks, but recovery milestones vary. You’ll likely be in the hospital for a few days of observation.

Many bariatric surgeries are laparoscopic, meaning the surgical invasion is minimal in nature. There is generally less pain as a result, and the recovery process is quicker. However, all surgeries carry the risk of complications such as secondary infections: bariatric surgery is no exception.

You will have several follow-up appointments after your surgery, at first to assure your continued surgical recovery and afterward to ensure your long-term health. You will likely require a high-protein diet in order to meet your new nutritional needs and will often find yourself eating much smaller but more nutritious meals. Your specific diet will often include vitamin and/or mineral supplements.

Bariatric surgery can drastically improve, reduce or even resolve serious comorbidities. As a result, your medication needs may be reduced. You may find behavioral therapy helpful, as you learn to adjust to your new eating habits. Regular exercise is strongly recommended as part of a long-term continued health plan, although Medicare does not cover gym memberships.

To lower the chances of needing one of these surgeries, consider making some lifestyle changes.

Consider changing these to avoid bariatric surgery:
  • Medications
  • Vitamin and mineral supplements
  • Diet
  • Level of exercise

Medicare’s Coverage of Weight Loss Surgery Frequently Asked Questions

What can disqualify you from bariatric surgery?
If you do not meet all of the requirements, you might be disqualified for coverage by Medicare. In addition, you might not qualify if you are over 65 or have an underlying health condition (like blood clots) that would make surgery dangerous.
Can you get excess skin removed on Medicare?
Cosmetic surgical procedures that are considered medically necessary are often covered at least in part by Medicare. Excess skin removal after drastic weight loss is often covered. Contact Medicare before your surgery to determine whether yours will be covered.
Does Medicare pay for gastric balloon surgery?
Currently Medicare does not cover gastric balloon surgery.

Editor Samantha Connell contributed to this article.

Last Modified: January 17, 2023

4 Cited Research Articles

  1. American Society for Metabolic and Bariatric Surgery. (2021, July). Metabolic and Bariatric Surgery. Retrieved from https://asmbs.org/resources/metabolic-and-bariatric-surgery
  2. Doble, B. et al. (2017, May 26). What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses. Retrieved from What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses - PMC (nih.gov)
  3. Medicare.gov. (n.d.). Check The Status of a Claim. Retrieved from https://www.medicare.gov/claims-appeals/check-the-status-of-a-claim
  4. American College of Gastroenterology. (n.d.). Find a Gastroenterologist. Retrieved from https://gi.org/patients/find-a-gastroenterologist/