Does Medicare cover bariatric sleeve surgery?

Does Medicare cover bariatric sleeve surgery? According to the Centers for Disease Control and Prevention (CDC), nearly 40% of US adults struggle with severe obesity. Obesity increases the chance of major health risks that can lead to a shortening of the lifespan. When looking for treatment for obesity, weight loss surgery – such as bariatric surgery – is one of the most considered weight loss procedures.

Medicare covers bariatric surgery as long as you meet the right conditions on a regional basis for morbid obesity. Original Medicare will cover the procedure either under Part A or Part B depending on whether the procedure is inpatient or outpatient. You will have to pay applicable deductibles and coinsurance amounts. A Medicare Supplement plan can help cover those costs. If you have Medicare Advantage for your health insurance, your costs and coverage may be different.

If you’d like to shop for a Medicare Advantage plan or Medicare Supplement plan to cover bariatric sleeve surgery, enter your ZIP code now.

Will Medicare pay for bariatric sleeve surgery?

Medicare does cover bariatric surgery procedures on a regional basis when medical conditions related to morbid obesity are met. According to Medicare.gov, the coverage may be either Part A if it’s inpatient surgery; or Part B if it’s an outpatient surgery. To find out if the surgery is available in your region, speak with your provider.

To be eligible to have the cost of surgery covered by Medicare, the patient has to meet these requirements:

• BMI of 25 or higher
• Previous obesity medical treatment that was not successful
• Illness associated with obesity, including diabetes, heart disease, sleep apnea, high cholesterol, high blood pressure, and certain other conditions

If you have Medicare Advantage, your coverage is through a private insurance company, Contact your Medicare Advantage provider to find out what your particular plan covers.

Read more: Can you get life insurance with high blood pressure?

What is the out-of-pocket cost for bariatric sleeve surgery?

If you have Original Medicare, you will have to pay your deductible as well as 20 percent health care coinsurance if you’re using your Part B coverage for outpatient treatment. A Medicare Supplement plan can cover some or all of these out-of-pocket costs.

If you have a Medicare Advantage plan, your plan will determine any deductibles or coinsurance amounts. Plans can differ quite a bit, so check your summary of benefits. You can also request a summary of the expected cost before the procedure.

Case Studies: Medicare Coverage for Bariatric Sleeve Surgery

Case Study 1: Medicare Coverage for Bariatric Sleeve Surgery

A 58-year-old woman with severe obesity in Region A of the United States is considering bariatric sleeve surgery as a weight loss option. She wants to know if Medicare will cover the procedure.

After meeting the eligibility requirements and consulting with her healthcare provider, she discovers that Medicare will cover the surgery under Part A since it is an inpatient procedure. She will be responsible for the deductibles and coinsurance amounts associated with the coverage.

Case Study 2: Medicare Advantage Coverage for Bariatric Sleeve Surgery

A 65-year-old man with morbid obesity in Region B is enrolled in a Medicare Advantage plan. He wants to explore the coverage options for bariatric sleeve surgery under his plan.

He contacts his Medicare Advantage provider and learns that the coverage and costs may vary. He receives detailed information on the deductibles, coinsurance, and other out-of-pocket costs associated with the surgery under his specific plan.

Case Study 3: Medicare Supplement Plan for Bariatric Sleeve Surgery

A 72-year-old woman with severe obesity in Region C has Original Medicare and wants to minimize her out-of-pocket costs for bariatric sleeve surgery. She decides to enroll in a Medicare Supplement plan to help cover the deductibles and coinsurance amounts.

By comparing different Medicare Supplement plans available in her area, she finds a plan that suits her needs and provides the desired coverage for the surgery.

Does Medicare cover bariatric sleeve surgery? The Bottom Line

Medicare coverage for bariatric sleeve surgery is available on a regional basis. You will have to meet Medicare’s criteria for eligibility in order to have the procedure covered. There will be out-of-pocket costs, but Medicare Supplement insurance can help to pay them.

To compare Medicare plans for bariatric sleeve surgery today, enter your ZIP code below.