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Does Medicare cover weight-loss programs or surgery?

Yes, Medicare covers weight-loss counseling and some types of surgery 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.

Does Medicare cover weight-loss counseling?

Yes, Medicare Part B covers weight-loss counseling if you have a BMI of 30 or higher and a medical professional conducts the session. This is considered a preventive service.

Most counseling sessions entail an initial obesity screening, a dietary assessment and behavioral therapy designed to help you lose weight by focusing on diet and exercise.

A primary care provider — such as a physician, clinical nurse specialist, nurse practitioner or physician assistant — must conduct the counseling within a primary care setting for Medicare to cover the service. Medicare will cover face-to-face meetings 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 will cover the 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.

Bear in mind that original Medicare doesn’t cover weight-loss programs not considered preventive, such as fitness or gym programs; Food and Drug Administration (FDA)-approved diet pills or medications; meal delivery services; and popular weight-loss programs such as Jenny Craig, Noom and WW (formerly Weight Watchers).

However, if you have a Medicare Advantage plan, you may have coverage for gym memberships and some weight-loss and healthy-food-delivery programs. These are considered expanded supplemental benefits and have gradually been added to some plans to provide coverage for nutrition, health and wellness.

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.

Medicare covers a few types of bariatric surgery, although it doesn't cover all surgeries that can treat obesity and related diseases. Two of the more common surgeries it covers 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 must also be able to show that 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.

What is considered healthy body fat?

Not surprisingly, the recommended amount of body fat is different for men and women.

For women, the Centers for Disease Control and Prevention (CDC) recommends an ideal body fat of 20 percent to 21 percent. The average American woman has 22 percent to 25 percent body fat.

For men, the recommended amount of body fat is 13 percent to 17 percent. The average for American men is 17 percent to 19 percent body fat. 

Keep in mind

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

Published November 3, 2022

     

        


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