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Does Medicare cover weight-loss programs or surgery?


Yes, Medicare covers weight-loss counseling and specific surgeries for people who have a body mass index (BMI) of 30 and above and meet other criteria.

Your BMI is an estimate of your body fat based on your height and weight. AARP’s BMI calculator is a helpful, interactive tool that allows you to calculate your BMI and identify where your weight falls on a scale of underweight, healthy, overweight or obese.

A BMI of 30 or higher, considered obese, increases your risk for many health conditions, such as some cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea. A BMI of 40 or more is considered severely or morbidly obese, which carries even more dangerous health risks.

Ideally, a healthy BMI should be between 18.5 and 24.9, but BMI isn’t an entirely accurate measure of the weight you carry on your frame. For example, it doesn’t take into account how much fat you carry or where the fat is distributed, factors that can affect your metabolic health. It also doesn’t account for significant muscle mass.

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Does Medicare cover weight-loss counseling?

Medicare Part B covers weight-loss counseling by a primary care provider — such as a physician, clinical nurse specialist, nurse practitioner or physician assistant — within a primary care setting for those with a BMI of 30 or higher.

This in-person preventive service typically entails an initial obesity screening, a dietary assessment and behavioral therapy designed to help you lose weight by focusing on diet and exercise, held:

  • Once every week for the first month.
  • Once every other week for the second through sixth month.
  • Once every month for the seventh month through your 12-month limit.

Medicare covers counseling sessions for months seven through 12 if you’ve lost at least 6.6 pounds by your six-month appointment. If you don’t meet the 6.6-pound target at this weigh-in, you may be able to try again after a six-month waiting period.

Original Medicare doesn’t cover fitness programs or meal delivery services, but if you have a Medicare Advantage plan, you may have coverage for gym memberships and some weight-loss and healthy food delivery programs or even a grocery allowance.

Does Medicare cover weight-loss surgery?

Yes, Medicare covers some types of bariatric and metabolic surgery for people who meet certain conditions associated with morbid obesity — a BMI of 35 or above and other conditions, such as diabetes, high blood pressure, high cholesterol and even sleep apnea. The procedures make changes to your digestive system to help you lose weight and improve the health of your metabolism.

Two of the more common Medicare-covered surgeries include:

  • Roux-en-Y gastric bypass surgery, which reduces the stomach to a small pouch that makes you feel full even following small meals.
  • Laparoscopic adjustable gastric banding, which inserts an inflatable band that creates a gastric pouch encircling the top of the stomach.

To qualify for Medicare coverage of bariatric procedures, you must have a body mass index of 35 or higher and at least one other condition related to obesity, such as diabetes or heart disease. You also need to show you’ve been unsuccessful with obesity treatment in the past, such as documentation of a counseling program or an order from your doctor.

Medicare doesn’t cover elective cosmetic surgery, such as liposuction.

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Keep in mind

Medicare’s Part D prescription plans won’t cover medications to help you manage your weight, including drugs used to treat anorexia, weight gain or weight loss.

While Medicare covers Ozempic only when prescribed for type 2 diabetes, it won’t cover the drug for weight loss, nor will it cover other drugs that are only approved by the FDA for weight loss but not for other conditions, such as Wegovy. Some employer health plans may cover them.

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