En español | Q. I’m overweight and worried I could get diabetes. I’ve tried diets without much success. Can Medicare help me lose the pounds and keep them off?
A. Maybe. That depends on whether you tip the scales at the point where you would be considered not just overweight but obese. Medicare has just begun covering counseling sessions to help obese people lose weight. Shedding those extra pounds greatly reduces your risk of not only diabetes but also heart disease, high blood pressure, breathing problems and some cancers.
The new coverage means that, for the first time, Medicare will pay doctors to discuss weight problems with patients, advise them on diet and exercise, monitor progress and provide encouragement in regular visits. Patients enrolled in Medicare Part B pay no copays or deductible for these visits.
To qualify for free counseling, your body mass index — called BMI — must be 30 or higher — a score that currently applies to more than a third of Medicare beneficiaries, according to Medicare officials.
As a first step, you can use an online BMI calculator, such as the one provided by AARP. Enter your height and weight, and it instantly calculates your BMI number. In general, a BMI of 18.5 to 24.9 is considered normal; 25 to 29.9 is overweight; and 30 or higher is obese.
The Medicare counseling coverage includes:
- One session every week for the first month
- One session every other week for months 2 through 6
- Monthly sessions for a further six months (7 through 12) if you have lost at least 6.6 pounds by the sixth month.
If you don’t hit the required target of 6.6 pounds by the end of the first six months, you still get another shot. But you have to wait six months before Medicare will pay for you to try again, officials say. There is no limit to how many attempts you can make, provided that your body mass is still 30 or greater and that six months have gone by since the last attempt.
The counseling must be provided by a primary care doctor, nurse practitioner, clinical nurse specialist or physician assistant. Any of them can refer you to other facilities or specialists such as nutritionists, but you’ll have to pay for those. Medicare will cover only sessions that take place in a primary care setting.
If you’re interested in getting weight-loss counseling, remember that the coverage is so new that some doctors may not have heard about it. So you need to know that the program is officially called “Intensive Behavioral Therapy for Obesity,” and doctors should use billing code G0447 to submit to Medicare for reimbursement. If necessary, refer them to Medicare’s guidance for physicians on this topic.
Will doctors be able to help patients lose weight and keep it off? A recent study by the Center for Weight and Eating Disorders at the University of Pennsylvania showed that such counseling can work well, even in sessions lasting only five to seven minutes. But researchers also found that the best results came over a two-year period of more intensive counseling by doctors who had received a few hours of special training. Research by the STOP Obesity Alliance found that 89 percent of doctors believed they had a responsibility to help their patients lose weight, but 72 percent also said they lacked the training to do it.
Still, obesity experts have welcomed the Medicare coverage as an important step in encouraging both doctors and patients to treat the issue seriously.
Also of interest: Can Medicare help you quit smoking?
Patricia Barry is a senior editor with the AARP Bulletin.
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