Does Medicare Cover Bariatric Surgery?

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.

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

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

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.

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.

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%.

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.

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.

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.

Editor Samantha Connell contributed to this article.