Friday, September 22, 2023

Does Medicare Cover Any Weight Loss Programs

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Does Insurance Cover Weight Loss Programs


All health plans that conform to Affordable Care Act standards and Medicare must cover obesity screening and counseling as a form of preventative care at no charge to you. You dont owe any costs in these situations. Other types of health plans such as short-term coverage aren’t required to cover this type of care.

In addition, the National Conference of State Legislatures says 16 states require plans to cover additional forms of weight loss programs, including at least some coverage and reimbursement for:

  • Dietary or nutritional screening
  • Counseling and/or therapy for obesity, sometimes including weight loss programs

Another seven states require coverage for nutritional counseling or therapy, but only when the diagnosis or treatment is related to diabetes.

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1 Americas Health Rankings. . . Senior Report. Retrieved from

2 CMS. Coverage Decision Memorandum for Bariatric Surgery for Treatment of Comorbidities Associated with Morbid Obesity. . Retrieved from is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

The purpose of this communication is the solicitation of insurance. Callers will be directed to a licensed insurance agent with TZ Insurance Solutions LLC, TruBridge, Inc. and/or a third-party partner who can provide more information about Medicare Advantage Plans offered by one or several Medicare-contracted carrier. TZ Insurance Solutions LLC, TruBridge, Inc., and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult

Medicare has neither reviewed nor endorsed this information.

Check Out Your State’s Guidelines

As you seek out coverage for weight loss programs and procedures through Medicaid, remember that each state administers its own plan. There will be guidelines specific to your location that need to be considered. To find out more specific coverage rules, recommends, contact your state Medicaid office. The site’s Medicaid Coordination with Part D chart provides a brief overview of state coverages as well as links to local contacts for each state. With just a little research and initiative, you should be able to quickly discover what resources are available to you for weight loss under Medicaid in your state.


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What Weight Loss Services Does Original Medicare Cover

Original Medicare includes:

  • Medicare Part A, which covers inpatient care received in a hospital or skilled nursing facility as well as hospice care
  • Medicare Part B, which helps pay for outpatient services like doctor visits, durable medical equipment , lab work, mental health care, and much more

As pertains to weight loss, Medicare Part B also covers a variety of preventive services and screenings designed to help beneficiaries maintain a healthy weight. Parts A and B may even help pay for bariatric weight loss surgery. Gym memberships and similar fitness programs, however, are not covered by Original Medicare.

If you meet the qualifications, Medicare Part B may cover the following services designed to help beneficiaries with diet, exercise, and weight loss. Unless otherwise noted, you have no out-of-pocket costs for the following services and the Part B deductible does not apply.

Bariatric Surgery And Medicare Costs And Options

Does Medicare Cover Weight Loss Programs?

In addition to matching the above requirements, you will want to find a surgeon that accepts Medicare. Make sure you search for a surgeon that specializes in the types of surgery that you prefer, such as a gastric sleeve Medicare surgeon, or a gastric bypass Medicare surgeon.

Medicare does not cover 100% of the surgery. Youre out of pocket medical expenses to depend on the surgery and the price, but in most cases, you will be expected to pay roughly 20% of the costs of bariatric surgery, while Medicare covers the remaining 80%. Costs in the United States for bariatric surgery range from between $10,000 to $40,000, making your out of pocket costs for the surgery alone somewhere between $2,000 and $8,000.

Some of these fees may be covered by MediGap, if you are enrolled in Medicares supplemental insurance plan.

You will also be expected to cover 20% of additional costs, such as an inpatient hospital stay. Some components of surgery and recovery may also not be covered by Medicare. Be sure and talk about each and every cost of your surgery with your surgeon before electing for the procedure, and make sure that you understand which costs you will be responsible for, why, and whether or not they are crucial for your service.

*Note: Post-Weight Loss Plastic Surgery Not Generally Covered by Medicare

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Weight Loss Programs That Are Covered By Insurance

Many insurance companies offer good-health incentives to clients. These incentives provide insurance discounts to clients who improve or maintain healthy lifestyles. Various weight loss programs are covered by these programs, providing discounts of insurance premiums and paying for a percentage of the enrollment fee or the services offered by the diet program.

Obesity Screenings & Counseling

As long as you have Medicare Part B and have a BMI of 30 or higher, you are eligible for obesity screenings and counseling. The National Heart, Lung, and Blood Institute has a free BMI calculator on its website, but a doctors screening will be much more accurate. Your BMI is the percentage of your bodyweight that is made up of fat. Remember that some fat is healthy you are not aiming for a BMI of zero. A healthy BMI is between 18 and 25. Lower than 18 is too little, 25-30 is a bit high, and above 30 is obese.

When you do get your free obesity screening, you might consider behavioral counseling for body fat loss. Your primary physician should offer their own obesity counseling. If not, they might recommend another Medicare-covered service.

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Q: Does Health Insurance Cover Bariatric Surgery

A: Many plans do cover various forms of weight-loss surgery these days. This is true if you’re insured through an employer or a federal marketplace, Medicare, or Medicaid.

Not all plans cover all kinds of surgery. So look over your policy or talk with someone at your insurance company before you agree to anything.

Also, expect to have to meet certain requirements for your insurer to cover your bariatric surgery. Your BMI might have to be above a particular number, or you may have to prove you’ve tried and failed at other weight-loss methods.

The Above Policy Is Based On The Following References:

Kaiser Weight Loss Program Review | Kaiser Positive Choice Review (UNSPONSORED)
  • Abell TL, Minocha A, Abidi N. Looking to the future: Electrical stimulation for obesity. Am J Med Sci. 2006 331:226-232.
  • American Gastroenterological Association medical position statement on obesity. Gastroenterology. 2002 123:879-881.
  • American Obesity Association, C. Everett Koop Foundation, and Shape Up America! Guidance for treatment of adult obesity. Bethesda, MD: Shape Up America! October 1996. Available at: Accessed March 16, 2000.
  • American Society of Health-System Pharmacists, Inc. American Hospital Formulary Service Drug Information 98. Bethesda, MD: American Society of Health-System Pharmacists 1998.
  • Arena Pharmaceuticals. Belviq tablets, for oral use. Prescribing Information Zofingen, Switzerland: Arena revised June 2012.
  • Arterburn DE, DeLaet DE, Schauer DP. Obesity. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group July 2005.
  • Asp N G, Bjorntorp P, Britton M, et al. Obesity – problems and interventions. SBU Report No. 160. Stockholm, Sweden: Swedish Council on Technology Assessment in Health Care 2002.
  • Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004 8: iii-iv, 1-182.
  • Aventis Pharmaceuticals Inc. Tenuate . Prescribing Information. Bridewater, NJ: Aventis revised November 2003.
  • Bjorntorp P. Treatment of obesity. Int J Obes Relat Metab Disord. 1992 16:S81-S84.
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    Do Medicare Advantage Plans Cover Weight Loss Programs

    Medicare Part C, commonly known as Medicare Advantage, combines your Medicare Parts A and B benefits in a single health insurance plan. Federal guidelines established by the Centers for Medicare & Medicaid Services require all Advantage plans to provide the same benefits as Original Medicare. However, plans are not limited to that coverage and most â around 90 percent â provide additional benefits as well.

    Prescription drug coverage is the most common of these extras, but more and more Medicare Advantage plans are adding health and wellness benefits like gym memberships and fitness programs. Costs and coverage vary widely, so you need to compare options carefully to pick the best Advantage plan for your unique needs.

    The three most common Medicare Advantage fitness options are:

    • SilverSneakers: Includes live online classes and workshops, on-demand video workouts, a fitness app for your smartphone, and over 17,000 locations across the United States. Classes are designed specifically for seniors.
    • Renew Active: Includes a free gym membership, personalized fitness plan, Fitbit Community with premium content, online brain health program, and incentives to help keep you on track.
    • Silver& Fit: Members have access to free daily workouts online, video on-demand workouts, home fitness kits, and over 15,000 fitness centers.

    Check plan details to see whether an Advantage plan covers a gym membership or weight loss program.

    Whole Body Calorimetry And Composition And Whole Body Bioimpedance

    There is currently no established role for whole body bioimpedance for weight reduction or other indications. Current ACC/AHA guidelines on obesity mention no role for bioimpedance analysis . Current NICE obesity guidance states: “Do not use bioimpedance as a substitute for BMI as a measure of general adiposity.”

    Lingwood stated that there is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends. These researchers reviewed the literature regarding the use of bioelectrical impedance in neonates. It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts. Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates. The authors concluded that further research is needed into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realize the full potential of this technology.

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    What Types Of Weight Loss Procedures Are Covered Under Medicare

    Medicare offers financial assistance for weight loss procedures only if the procedure has been advised by the physician, such as preparing for bariatric surgery, or as part of your preventive care package.

    Does Medicare Cover Weight Loss Surgery

    Lets take a closer look at the different types of weight loss procedures currently covered by Medicare:

    How Does Obesity Affect Health Insurance

    Shocking Truth: Does Medicare Cover Weight Loss Programs?

    About 19% of children and 42% of adults are obese, according to the Centers for Disease Control and Prevention. Obesity has been tied to many health conditions, including:

    • Diabetes
    • Some types of cancer

    All told, obesity costs the health system $147 billion a year, the CDC says.

    A 2018 study published in the Journal of Obesity & Weight Loss found that the average percentage of expenditures for health care related to obesity during the years 2010 through 2015 was:

    • 9.21% for commercial insurance
    • 8.48% for Medicaid
    • 4.74% for patient out-of-pocket spending

    Given all these costs, can health insurance companies charge you higher premiums if youre obese?

    Health insurance companies can’t charge you more, but your employer can, Stegemann says.

    For instance, some companies will create a program that basically taxes you for certain bad habits, he says. You might pay more for health insurance if youre a smoker or if you are obese.

    Such programs arent common, but theyre becoming more so, Stegemann says. We are hearing of more and more of it over the last five years, he says.

    Stegemann believes employers have the right aim in mind, but theyre going about it the wrong way.

    They basically are wanting you to be healthy, but they don’t give you the tools to do it, he says, adding that many plans dont cover you for things like obesity medications or surgery or even a gym membership.

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    Does Medicare Cover Gastric Sleeve Surgery

    Medicare does cover gastric sleeve surgery when available in your service area. The level of coverage also depends on whether youre getting care as an inpatient or outpatient. Gastric sleeve surgery removes and separates about 85% of the stomach, and then the remaining gets molded into a tubular shape that cant contain much food or liquid.

    Patients lose an average of 65% of extra weight after gastric sleeve surgery, which may be why it was the fastest-growing bariatric surgery in 2019.

    Finding A Doctor For Obesity Treatment

    Your primary physician can at least help you get started on your obesity treatment but might refer you to a nutritionist or other specialist if necessary.

    Be sure to check with your plan network to make sure your doctors and specialists are covered. You can use Medicare.govs Physician Finder to find out if a doctor accepts Medicare, and visit your private plans website to find out if your doctor or specialist is in your plans network.

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    Ketogenic Diets For Weight Loss

    Gibson et al stated that VLEDs and ketogenic low-carbohydrate diets are 2 dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent. To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, these researchers conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analog scales before and during adherence to VLED or KLCD. Individuals were less hungry and exhibited greater fullness/satiety while adhering to VLED, and individuals adhering to KLCD were less hungry and had a reduced desire to eat. Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry . Ketosis appears to provide a plausible explanation for this suppression of appetite. The authors concluded that future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet.

    Does Medicare Cover Weight Loss Surgery Overview

    Gastric Bypass Surgery Approval | Medicaid

    Medicare is one of the most common and biggest health insurance providers in the US. Tens of millions of US citizens are part of the companys vast insurance coverage. Very often, we get queries about what types of treatments are covered under the health insurance, such as queries about whether Medicare covers weight loss procedures.

    Although Medicare does provide assistance with preventive services that help you maintain a healthy weight range, certain weight loss services are exempt from coverage, such as:

    • FDA-approved diet medicines or pills
    • Nutrisystem, Weight Watchers and similar programs
    • Meal delivery and similar services for weight loss

    On the other hand, original Medicare offers help for weight loss screenings and nutrition counseling, provided you fulfill the specific criteria. Besides, several Medicare Advantage plans also offer additional wellness and health services, including gym memberships and fitness programs.

    To help you, we have listed the number of disorders and their treatments that are covered under the Medicare health insurance program.

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    The Welcome To Medicare And Yearly Wellness Visits

    Medicare beneficiaries are highly encouraged to take advantage of two screenings, both covered 100 percent:

    • Welcome to Medicare
    • Annual Wellness Visit

    The Welcome to Medicare visit is available to all new beneficiaries once during their first 12 months with Medicare. After your first year with Medicare, you qualify for a yearly wellness visit, which is also provided at no cost to you.

    Both visits include a variety of metrics . You will also complete a Health Risk Assessment that helps your healthcare provider provide personalized health advice and develop a treatment plan.

    Your Welcome to Medicare and annual wellness visits are the perfect time to talk to your doctor about weight goals and healthy lifestyle changes you can make to meet them.

    Does Medicare Cover Xenical

    Xenical is the brand name for the generic prescription drug Orlistat, commonly used to treat obesity. Alli is the over-the-counter version of this medication. These medications work by blocking the absorption of ingested fat in the human body. This reduces the overall intake of calories and may lead to weight loss in some people.

    Doctors may prescribe Xenical for someone who has a body mass index of 30 or over. A BMI of over 30 indicates obesity. Being obese can lead to a long list of health complications like type two diabetes, high blood pressure, heart disease, fatty liver disease, some forms of cancer, and others.

    Looking at the numbers recorded over recent years, they show that cases of obesity are still on the rise in the United States. They now affect over 90 million American adults and currently cost the United States over $190 billion annually in medical bills.

    Your health care provider may prescribe Xenical to help you with weight loss. Physicians generally suggest that this drug be used as part of a sensible weight loss program that includes a healthy diet together with regular physical activity. Xenical is not meant to be taken on its own as a miracle weight loss cure.

    If you decide to try Xenical you should inform your health care provider about any other medications you are taking, or other health issues you have before you begin taking Xenical or similar drugs.

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