Original Medicare, Medicare Advantage, and Medigap may all provide coverage for gastric bypass surgery for people who meet certain criteria.
In 2019, more than 256,000 people in the United States had bariatric surgery, also known as weight loss surgery, according to the American Society for Metabolic and Bariatric Surgery.
Several types of bariatric surgery exist, including gastric bypass surgery. In this procedure, a healthcare professional changes the shape of a person’s stomach to help with weight loss.
This article will look at Medicare coverage, eligibility, and costs for gastric bypass surgery.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
When does Medicare cover gastric bypass?
Medicare covers bariatric surgical procedures, including gastric bypass surgery, when a person has certain health conditions related to obesity.
Medicare criteria for bariatric surgery include:
- having a body mass index (BMI) private individual health insurance coverage
- having at least one obesity-related comorbidity
- having tried other unsuccessful medical treatments for obesity
A person with an obesity-related health condition may also qualify for Medicare-subsidized gastric bypass surgery. Such conditions include:
- gallbladder disease
- heart disease
- high cholesterol
- high blood pressure
- osteoarthritis
- sleep apnea
- stroke
- some types of cancer
- type 2 diabetes
Medicare requirements can vary by state and individual insurance providers. However, people must usually provide the following information to qualify for coverage:
- the results of thyroid, adrenal, and pituitary blood tests, showing all results in a standard range
- the results of a psychological evaluation
- proof of participation in at least one unsuccessful weight loss program that a medical expert supervised
- a doctor’s referral for gastric bypass surgery
