Medicare's coverage for weight loss surgeries?
In 2025, individuals with Original Medicare can anticipate paying a Part A deductible of $1,676 and a Part B deductible of $257 before Medicare starts covering costs related to weight loss treatment. However, it's important to note that Medicare does not cover weight loss procedures for which there is insufficient evidence of their reasonableness and necessity.
For those considering bariatric surgery, it's essential to understand the associated out-of-pocket costs. These costs can vary depending on deductibles, coinsurance, and copayments.
Firstly, Medicare requires an annual deductible to be met before it starts covering costs. For outpatient care associated with weight loss treatment, this deductible falls under Medicare Part B. After meeting the deductible, Medicare generally covers 80% of approved costs, and the remaining 20% is the coinsurance that the individual is responsible for.
Coinsurance amounts for bariatric surgery covered under Part A or Part B would equate to approximately 20% of the Medicare-approved amount post-deductible. Copayments, while they typically apply more to outpatient visits or medications, might also be applicable for related services such as outpatient visits or nutritionist counseling under Part B.
Specifically for bariatric surgery coverage, Medicare Part A may cover the surgery if the individual has a body mass index (BMI) of 35 or higher and related health conditions like diabetes or heart disease. The surgery must be medically necessary and efforts to lose weight through diet and exercise should have been unsuccessful.
Bariatric surgery costs will be subject to the Medicare Part A hospital deductible for inpatient care. After this deductible, Medicare generally covers a large portion of the cost, but you may have coinsurance amounts to pay.
In summary, the exact out-of-pocket expenses depend on your specific Medicare plan (Original Medicare or Medicare Advantage), the facility, and whether you have supplemental coverage. However, expect to pay deductibles plus approximately 20% coinsurance on surgery costs under Original Medicare.
For more resources on navigating medical insurance, visit the Medicare hub. It's also worth noting that Medicare Advantage plans may provide coverage for weight loss aids such as membership to SilverSneakers, gym memberships, and healthy meal delivery services.
[1] Medicare.gov [2] Healthcare.gov [3] ASMBS.org [4] CMS.gov
- For switchers contemplating bariatric surgery, it's crucial to grasp the attached out-of-pocket expenses.
- The costs can fluctuate according to deductibles, coinsurance, and copayments.
- Medicare demands an annual deductible to be met before it begins covering costs, and for outpatient care associated with weight loss treatment, this deductible falls under Medicare Part B.
- After meeting the deductible, Medicare usually covers 80% of approved costs, while the remaining 20% is the coinsurance that the person is responsible for.
- Coinsurance amounts for bariatric surgery covered under Part A or Part B would amount to approximately 20% of the Medicare-approved amount post-deductible.
- Copayments, generally applicable more to outpatient visits or medications, might also be applicable for related services such as outpatient visits or nutritionist counseling under Part B.
- Specifically for bariatric surgery coverage, Medicare Part A may cover the surgery if a seeker has a body mass index (BMI) of 35 or higher and related health conditions like diabetes or heart disease.
- In summary, the exact out-of-pocket expenses depend on your specific Medicare plan (Original Medicare or Medicare Advantage), the facility, and whether you have supplemental coverage, but expect to pay deductibles plus approximately 20% coinsurance on surgery costs under Original Medicare.
Additional resources for navigating medical insurance can be found at Medicare.gov, Healthcare.gov, ASMBS.org, and CMS.gov. It's worth noting that Medicare Advantage plans may provide coverage for weight loss aids such as membership to SilverSneakers, gym memberships, and healthy meal delivery services.
