Medicare covers certain Bariatric procedures if deemed medically necessary. Below we discuss what procedures are covered and what to expect.
Overview
A weight loss surgery is a medical procedure you undergo to reduce your weight and lessen the risk and health problems that obesity may cause. Weight loss surgery occurs in two main ways:
- Restriction: In a restrictive weight loss surgery, your stomach size is reduced. The operation slows digestion because of the smaller size and the reduced amount your stomach can now hold. As a result, you eat less and can lose more weight.
- Malabsorption: Also known as Intestinal Bybass, this procedure shrinks your small intestine and changes the way you take in food. As a result, your body absorbs fewer nutrients and calories, therefore losing more weight.
The newest and least common weight loss procedure is the implant of an electronic device. The device interferes with signals sent between the brain and stomach. As a result, it can also cause weight loss.
What Are the Types of Weight Loss Surgeries?
There are three convenient options for weight loss surgery, they are:
Laparoscopic adjustable gastric band
Called a gastric band, this procedure uses a ring that contains an inflatable band. The surgeon uses the ring to make a small incision around the top of your stomach. Because of this ring, you feel fuller quicker and only after a little food intake.
Gastric sleeve
A gastric sleeve procedure is the most common weight loss procedure. It permanently removes a part of your stomach. Since there is only a small portion left, you can only eat a limited amount of food until your stomach is full.
Gastric bypass
Gastric bypass is also known as the Roux-en-Y procedure. The way the surgery goes is first a surgeon creates a pouch at the top of your stomach and staples it. Second, the surgeon connects the small intestine to the bag created. In the end, you have a much smaller stomach and eat much less.
Duodenal Switch
The fourth type of weight loss surgery is a duodenal switch. This weight loss surgery is also collectively called bariatric surgery.
As a side effect of the surgery, you may be unable to eat certain foods, have acid reflux, or an infection. You may also have dilated esophagus, nausea, vomiting, stomach obstruction, or weight gain.
Long term risks associated with the procedure include Hernias, bowel obstruction, ulcers, malnutrition, dumping syndrome, low blood sugar, and dizziness.
Why you may need a Bariatric Surgery
More than 90 million people are overweight in the United States and more than 70 million people suffer from obesity. In a 2016 National Health and Nutritional Examination Survey (NHANES) report, 39.8% of adult people in America are obese. Defined from the context of BMI, a Body Mass Index of 35 to 39.9 constitutes obesity. In 2018, up to 42% of Americans were obese (CDC Report).
In 2018, the United States recorded a total of 228,000 weight loss procedures; this is only about 1% of the eligible population.
You can perform bariatric surgery to reduce weight and reduce the risk of problems that extreme obesity causes. Consequently, it may be an option if you have a Body Mass Index (BMI) of 39.9 or higher.
Also, if you have a BMI between 35.5-39.9, bariatric surgery may be recommended if you have an accompanying condition:
- Heart disease
- Type II Diabetes
- Stroke
- Sleep Apnea
- High blood pressure or cholesterol
- Respiratory problems
- Gallbladder disease
- Certain cancers
It is essential to have attempted losing weight through exercise regimens and diet changes before getting a weight loss procedure. Bariatric surgery cannot substitute for a healthy lifestyle.
Medicare and Bariatric Procedures
If you have Medicare Part A and Part B (Original Medicare), you are covered for the Bariatric procedure, if you meet certain requirements.
The pre-approval requirements for Medicare coverage of the procedure include:
- BMI of more than 35 and one co-morbidity (Co-morbidity is one of the illnesses that obesity causes.
- Must have had obesity for up to 5 years and have documents to prove it.
- The patient must have tried futilely in at least one weight loss program that is medically approved and supervised.
- You must pass a psychological evaluation.
- A recommendation letter from your doctor, approving the surgery.
- Present that there is no other medically treatable condition causing your obesity. You may need to do a pituitary test, thyroid, and adrenal screening tests to confirm this.
If you are eligible after the pre-approval requirements, Medicare will cover your bariatric procedures. As well as: gastric bypass, duodenal switch, and laparoscopic banding.
Does Medicare Cover the Cost of Bariatric Surgery?
Bariatric surgery is an expensive procedure, costing between $15,000 to $25,000. Medicare does not cover all the costs of the operation, but you may be able to lower the cost with a Medicare Supplement plan (Medigap).
To qualify for Medicare’s coverage of the procedure, you must have paid your annual deductible. You can’t be sure of exactly how much you have to pay because no one will know what the procedure may include. The cost depends on if it’s an inpatient or outpatient service. In addition, you may also have surgery-related complications.
How to Lower the Cost of Weight Loss Surgery
If you have Original Medicare, you still have to pay for Part A and B deductibles (up to $1,600). You also have to pay the part B coinsurance of 20%. To save money on these costs consider a Medicare Supplement plan or Medicare Advantage plan. These plans will help cover the rest of the surgery cost so you don’t have to pay out of pocket.
The safest form of weight loss surgery is gastric banding. This is the safest because it does not interfere with nutrient absorption so therefore there is less risk of nutrient deficiency. However, it’s important to take into account that patients are most likely to regain weight in the long run since weight loss is lower.
Because patients need to go through a pre-approval process it takes about 3-4 months to approve for bariatric surgery.
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Contact us at 800-208-4974 for any questions you may have about Medicare-covered procedures and surgeries. We would love to help you out.
