FAQ – Medicare & Medicaid
Does Medicare & Medicaid Cover Weight Loss Surgery?
Medicare & Medicaid
Overview of Medicare
Medicare is a federally funded health insurance program that is available to people age 65 or older or for people under 65 with qualifying disabilities. Morbid obesity is one of the qualifying disabilities under the Social Security Act. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). To determine if you qualify for Medicare coverage or want additional information, contact the local social services agency in your area or check out the website for either the CMS (www.cms.hhs.gov) or the HHS (www.hhs.gov).
Overview of Medicaid
Medicaid is a federally funded health insurance program that provides health care and related health-services to qualifying low-income people. The Medicaid program is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). Medicaid eligibility is based on income and other factors such as age, disabilities, citizenship, and other resources. If you want more information or want to see if you qualify for Medicaid, contact the local social services agency in your area or check out the website for either the CMS (www.cms.hhs.gov) or the HHS (www.hhs.gov). Medicaid coverage for Gastric Bypass and lap band surgery is decided on a state by state basis.
Medicare Coverage for Gastric Bypass and Lap Band Surgery
Medicare will cover weight loss surgery surgery for qualified patients when the procedure is performed by approved surgeons and facilities.
This list is at the US Department of health & Human Services web site.
Medicare coverage and requirements went into effect on February 15, 2006. Like many insurance programs, Medicare patients may have a co-payment amount even if they qualify. Although Medicare pays for weight loss surgery, they do not pre-authorize so it is important to be certain of the requirements for surgery coverage.
Medicare qualified patients are Medicare beneficiaries who have a BMI (body mass index) greater than 35, have at least one co-morbidity related to obesity, have been unsuccessful in losing weight with previous medical treatments for obesity, and lap band surgery is considered a medical necessity. Approval for weight loss surgery is not automatic, but reviewed on a patient by patient basis.