Original Medicare may cover some weight management services but doesn’t generally cover most weight loss programs, services, or medications.Some Medicare Advantage plans cover health and wellness services that relate to weight loss, such as fitness programs and gym memberships.In cases when it’s medically necessary, Medicare will cover weight loss surgery if you meet the eligibility requirements.
According to a 2013–2016 survey by the Centers for Disease Control and Prevention (CDC), almost half of U.S. adults attempted to lose weight within the past 12 months.
In addition to diet and lifestyle changes, weight loss programs are a popular option for people who want to lose excess weight. However, Medicare covers weight loss programs only when they’re deemed “medically necessary.”
In this article, we’ll explore when Medicare will cover weight loss programs, what services Medicare covers, and how to get the best Medicare coverage to help you maintain a healthy weight for you.
While Medicare offers a variety of preventive services to help you attain a healthy weight, it generally doesn’t cover weight loss services, programs, or medications. These include:
services such as meal delivery for weight lossprograms such as Nutrisystem or Weight WatchersFDA-approved diet pills or medications
However, there are some cases when original Medicare will provide preventive weight loss screenings and nutrition counseling — as long as you meet the eligibility criteria.
In addition, some Medicare Advantage (Part C) plans offer additional health and wellness services, like fitness programs and gym memberships.
Let’s dive into exactly what programs and services Medicare covers that may help with weight loss.
Medicare doesn’t offer weight loss services for all enrollees unless it’s necessary for a medical procedure, such as to prepare for bariatric surgery, or as part of your preventive care.
Let’s go over the eligibility rules for each Medicare-covered service for weight loss.
Obesity screenings and counseling
If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling.
These preventive services must be performed by your doctor or primary care physician in a doctor’s office or primary care setting. They include:
obesity screeningdietary assessmentnutrition counseling
Obesity screenings and behavioral counseling are considered preventive services, which are covered under Medicare Part B. Part B is one part of original Medicare.
Most of these services will cost you nothing out of pocket as long as you’ve met your Part B deductible for the year.
Medical nutrition therapy (MNT) is often used to treat and manage certain health conditions, such as diabetes or kidney disease. This type of therapy includes:
nutrition and lifestyle assessmentnutritional therapy sessionslifestyle managementfollow-up visits
Medicare will cover MNT if you have either of the conditions mentioned above or have had a kidney transplant within the last 36 months. Dialysis patients also receive MNT as part of standard care.
MNT is considered preventive, so there’s no out-of-pocket cost for these services. However, your doctor will need to refer you to a registered dietitian for counseling.
Original Medicare doesn’t cover gym memberships or fitness programs.
However, some Medicare Advantage plans offer health and wellness benefits that cover these types of services. These may include:
SilverSneakers: one of the most popular fitness programs for adults age 65 and olderRenew Active: a program by UnitedHealthcare that covers gym memberships and other health and wellness programs and eventsSilver&Fit: another fitness program that offers nationwide services both in person and online
Before you enroll in a Medicare Advantage plan, check what kind of coverage it offers for these programs. Plans that include this type of coverage might have additional costs, depending on the company.
Again, if you have original Medicare (parts A and B), you won’t be covered for any of programs. You’ll pay the full price of these services out of pocket.
Weight loss surgery
In some cases, bariatric surgery may be medically necessary for extreme weight loss. While Medicare doesn’t cover weight loss surgeries for appearance reasons, it will cover bariatric surgery if you meet the following criteria:
a BMI of 35 or higherat least one underlying health condition related to obesityprevious unsuccessful medical attempts at weight loss
Medicare coverage of these procedures includes both malabsorptive and restrictive bariatric procedures, such as:
Roux-en-Y gastric bypassbiliopancreatic diversion with duodenal switchadjustable gastric bandingsleeve gastrectomyvertical gastric banding
Medicare will cover bariatric surgery if you meet the eligibility criteria listed above. However, you’ll owe the standard Medicare plan costs for the procedure, which may include:
any deductibles you haven’t already paidcopayments for doctor’s and specialist’s visitscoinsurance for any procedures
Most weight loss interventions, unless preventive or medically necessary, aren’t covered by Medicare. Noncovered weight loss interventions may include:
weight loss programs such as Weight Watchers or Nutrisystemweight loss procedures purely for aesthetic purposes, such as liposuctionweight loss medications, including FDA-approved “diet pills”
Although Medicare does cover most bariatric surgery procedures, it doesn’t cover the following bariatric procedures:
gastric balloonintestinal bypassopen adjustable gastric bandingopen sleeve gastrectomylaparoscopic sleeve gastrectomyopen vertical banded gastroplastylaparoscopic vertical banded gastroplasty
If you enroll in any of these noncovered programs or undergo any of these services, you may end up paying the full cost out of pocket.
These costs can range from less than $100 per month for programs like Weight Watchers, to between $2,000 to $4,000 for procedures like liposuction.
Medicare enrollees who are interested in extra health and wellness coverage for weight loss should compare Medicare Advantage plans in their area.
Most Medicare Advantage plans offer additional coverage beyond what original Medicare covers — especially when it comes to perks such as fitness programs and gym memberships.
If you meet the coverage criteria listed above for weight loss surgery, you don’t need to enroll in a Medicare Advantage plan to be covered for these services. They’ll be covered under your original Medicare plan.
However, if you would like additional long-term support after surgery, Medicare Advantage plans may offer these health and wellness perks.
Even if your Medicare plan doesn’t cover the weight loss services you’re interested in, there are some dietary and lifestyle changes you can make on your own, including:
Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, and healthy fats. Focus on lean protein and eat red and processed meats in moderation.Enjoy refined carbohydrates, such as sweets and soda, in moderation. These foods have a low nutritional value and often take the place of more nutritious options.Drink water often and make it your primary drink throughout the day. Soda, alcohol, and other beverages are fine in moderation but can add extra calories.Find a diet that works for you in the long term and avoid overly restrictive or dangerous fad diets. Always reach out to your doctor first before making any major dietary changes.
Weight loss programs can offer a great support system to help you meet your weight loss goals. However, original Medicare won’t cover most weight loss services unless they’re preventive or your doctor has decided that they’re medically necessary for your situation.
If you want Medicare coverage for these extra services, such as gym memberships and fitness programs, you’ll need to find a Medicare Advantage plan that meets your needs.
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