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.
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- Published: January 13, 2023
- Updated: February 22, 2023
- 6 min read time
- This page features 4 Cited Research Articles
- Edited By
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.
|Type of Medicare Plan||Available Coverage for Surgery|
|Plan A||Part 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 Advantage||The amount of your Medicare Advantage coverage will depend on your specific plan|
|Part D: Prescription Drugs||No coverage|
|Supplemental Insurance||Any 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.
- 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.
- Type 2 diabetes
- Sleep apnea
- Hypertension (high blood pressure)
- Joint or back pain
- Soft tissue infections
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.
- 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.
- Vitamin and mineral supplements
- Level of exercise
Medicare’s Coverage of Weight Loss Surgery Frequently Asked Questions
Editor Samantha Connell contributed to this article.
4 Cited Research Articles
- American Society for Metabolic and Bariatric Surgery. (2021, July). Metabolic and Bariatric Surgery. Retrieved from https://asmbs.org/resources/metabolic-and-bariatric-surgery
- 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)
- Medicare.gov. (n.d.). Check The Status of a Claim. Retrieved from https://www.medicare.gov/claims-appeals/check-the-status-of-a-claim
- American College of Gastroenterology. (n.d.). Find a Gastroenterologist. Retrieved from https://gi.org/patients/find-a-gastroenterologist/
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