Medicare & Bariatric Surgery

Bariatric surgery can be very expensive. It is the last option or many who are overweight and can cost anywhere between $17,000 and $30,000 depending on the type of surgery and the location of the medical facility.

For many, Medicare seems like it might be the only way to cover the bariatric surgery that might save their lives. Will Medicare cover weight loss surgery, though?

Medicare does, in fact, cover some kinds of bariatric surgery, including gastric bypass, lap gastric band, duodenal switch, realize band, and gastric sleeve surgery. Note that gastric sleeve surgery is covered on a regional basis. However, they will not simply cut you a check right away. Patients looking to undergo bariatric surgery must meet several requirements first.

A doctor must write a letter recommending weight loss surgery and certify that the patient meets the following criteria:

• Has a Body Mass Index (BMI) of 35 or greater
• Has at least one comorbidity factor. A comorbidity factor refers to a serious illness that is in some way related to weight, including diabetes or sleep apnea
• Medical records must show that the patient has been obese for a minimum of 5 years
• The patient has attempted at least one other weight loss program and failed to lose weight
• Has passed a psychological evaluation
• Other treatable diseases have been ruled out. Adrenal, pituitary, or thyroid screening tests have been completed and have returned normal

All of these requirements must be met and medically certified. If you have a BMI above 40 but no weight-related medical conditions, you may not qualify for Medicare coverage of bariatric surgery.

While it used to be that you had to have weight loss surgery performed a facility that had been accredited as a Bariatric Center of Excellence, this is no longer the case. You may still want to seek out one of these accredited facilities, however, since they have undergone routine inspections from medical professionals and have high standards of reporting.  

The staff at these Centers of Excellence has to undergo extensive training specifically or bariatric surgery.

They have to perform a minimum number of bariatric surgeries a year to maintain their status. Getting your surgery done at a Bariatric Center of Excellence will help you prepare and recover from the surgery and going to one is a good idea even if it isn’t a requirement.

If you are considering undergoing experimental treatments, know that Medicare will absolutely not cover these surgeries. Contact Medicare and check Medicare’s Weight Loss Surgery Policy if you are not sure if the surgery you are considering will be covered.

If you and your doctor have concluded that bariatric surgery is the best thing to do for your health or that of a loved one, Medicare can cover it. Be sure to start getting the required tests done as soon as possible in order to move the process along and keep detailed records.

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