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.

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.

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.