Your weight matters, and understanding how Medicare addresses weight-related concerns—from counseling to surgical interventions—is crucial.
Whether pursuing preventive measures or contemplating transformative options, read on to navigate the intricate balance between Medicare coverage and your journey toward a healthier lifestyle. If you have further questions on Medicare coverage or need guidance tailored to your unique situation, schedule an appointment with The Medicare Family. We’re here to assist you every step of the way.
Does Medicare cover weight-loss programs or surgery?
Yes, if you have a BMI over 30 and meet other criteria, Medicare will cover some weight loss prevention services and surgery.
Body Mass Index (BMI) is a number that represents the relationship between a person’s weight and height. It’s used as a general indicator of whether a person’s weight is within a healthy range or if they might be underweight, overweight, or obese. You can calculate your BMI here.
What does Medicare not cover?
When we say “weight-loss programs,” we are not referring to programs such as Weight Watchers or Nutrisystem. We mean situations where a doctor, dietician, or other health professional provides preventative services or counseling.
Weight loss surgery must be medically necessary for Medicare to provide coverage. Medicare does not cover cosmetic surgery.
Finally, Medicare does not cover medications such as Ozempic when used solely for weight loss. They are covered when your doctor prescribes them to treat your diabetes or for other FDA-approved uses.
What does Medicare cover?
Medicare does provide some coverage to help you lose weight.
Weight Loss Counselling
Medicare Part B offers coverage for weight-loss counseling as a preventive service if your Body Mass Index (BMI) is 30 or higher and a medical professional conducts the sessions.
Your counseling will include an initial obesity screening, dietary assessments, and behavioral therapy, all aimed at supporting weight loss through diet and exercise. The counseling must be administered within a primary care setting by a qualified healthcare provider, such as a physician, nurse practitioner, or physician assistant. The coverage includes face-to-face meetings:
- Weekly for the first month
- Biweekly for the second through the sixth month
- Monthly for the seventh month through your 12-month limit
Medicare will continue covering counseling sessions from the seventh to the twelfth month if you lose at least 6.6 pounds by your six-month appointment. If the target weight loss is not met at this weigh-in, you may try again after a six-month waiting period.
Weight Loss Surgery
Medicare Part A provides coverage for specific types of bariatric and metabolic surgeries. To qualify, your Body Mass Index (BMI) must be 35 or higher, and you must have other conditions like diabetes, high blood pressure, high cholesterol, or sleep apnea. Additionally, you must prove unsuccessful attempts at obesity treatment, such as counseling programs.
While Medicare covers certain bariatric surgeries, it does not cover all procedures. The most common surgeries that are covered are:
Roux-en-Y gastric bypass surgery: This reduces the stomach to a small pouch to induce a feeling of fullness after consuming even small meals and
Laparoscopic adjustable gastric banding: This involves placing an inflatable band around the top of the stomach to create a gastric pouch
It does not cover procedures such as a gastric balloon, intestinal bypass, and open vertical banded gastroplasty.
SilverSneakers
SilverSneakers is a fitness program covered by some Medicare Advantage plans. It caters to seniors, promoting their physical health and overall well-being. SilverSneakers offers a range of exercise classes, wellness resources, and community support tailored to the needs and capabilities of older adults.
Beyond physical exercise, SilverSneakers offers a sense of community that fosters social connections among seniors. You can engage with others in the community, share your fitness journeys, and build meaningful relationships.
Managing your weight
A significant portion of seniors in the United States, nearly 30%, are classified as obese, indicated by a body mass index (BMI) exceeding 30.
As individuals age, weight management can become increasingly challenging. This difficulty can arise from various factors. Metabolism tends to decelerate, medical conditions might interfere with regular physical activity, certain medications may have weight gain as a side effect, and evolving lifestyles can lead to reduced activity or dietary changes.
Here are just a few suggestions to help you manage your weight:
Consult Healthcare Professionals: Before embarking on any weight loss journey, it’s crucial to consult with healthcare providers. They can assess your overall health and recommend suitable approaches.
Balanced Diet: Focus on a well-balanced diet rich in fruits, vegetables, lean proteins, whole grains, and healthy fats. Portion control is vital to managing calorie intake.
Physical Activity: Engage in regular physical activity that suits your abilities and medical conditions. Walking, swimming, and chair exercises can contribute to weight management.
Behavioral Changes: Adopt mindful eating practices to prevent overeating. Address emotional eating triggers and establish healthy coping mechanisms.
Social Support: Joining groups like SilverSneakers, which offers fitness classes designed for seniors, can provide social interaction and physical activity opportunities.
Let’s Find the Best Medicare Plan for You!
Medicare can be confusing, especially when it comes to weight-related services. From what we learned, Medicare does offer some help for weight loss, covering counseling sessions if you have a high BMI. They even cover specific surgeries if they’re needed for health reasons and not just looks. But they won’t pay for every weight loss program or pill out there.
But don’t worry! Our team at The Medicare Family is here to help. We’ll show you all the Medicare choices and help you pick the best one. Want to understand Medicare better and feel good about your choice? Reach out to us! Schedule an appointment to talk with someone on our team today.
