Does Medicare cover bariatric sleeve surgery?
Medicare covers bariatric sleeve surgery on a regional basis. To have bariatric sleeve surgery covered by Medicare, you will have to meet a list of eligibility requirements. Under Original Medicare, bariatric surgery may be covered under either Part A or Part B, and those deductibles and coinsurance amounts will apply. Coverage for bariatric sleeve surgery with Medicare Advantage plans varies.
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UPDATED: Jan 20, 2021
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- Medicare covers bariatric sleeve surgery on a regional basis
- You will need to meet Medicare eligibility criteria for coverage
- Out-of-pocket costs include deductibles and coinsurance
Does Medicare cover bariatric sleeve surgery? Medicare covers bariatric surgery as long as you meet the right conditions on a regional basis. Original Medicare will cover the procedure either under Part A or Part B depending on whether the procedure is inpatient or outpatient. You will have to pay applicable deductibles and coinsurance amounts. A Medicare Supplement plan can help cover those costs. If you have Medicare Advantage for your health insurance, your costs and coverage may be different.
If you’d like to shop for a Medicare Advantage plan or Medicare Supplement plan to cover bariatric sleeve surgery, enter your ZIP code now.
Will Medicare pay for bariatric sleeve surgery?
Medicare does cover bariatric sleeve surgery on a regional basis when conditions related to morbid obesity are met. According to Medicare.gov, the coverage may be either Part A if it’s inpatient surgery and Part B if it’s an outpatient surgery. To find out if the surgery is available in your region, speak with your provider.
To be eligible to have the surgery covered by Medicare, the patient has to meet these requirements:
- BMI of 25 or higher
- Previous obesity treatment that was not successful
- Illness associated with obesity, including diabetes, heart disease, sleep apnea, high cholesterol, high blood pressure, and certain other conditions
If you have Medicare Advantage, your coverage is through a private insurance company, Contact your Medicare Advantage provider to find out what your particular plan covers.
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What is the out-of-pocket cost for bariatric sleeve surgery?
If you have Original Medicare, you will have to pay your deductible as well as 20 percent health care coinsurance if you’re using your Part B coverage for outpatient treatment. A Medicare Supplement plan can cover some or all of these out-of-pocket costs.
If you have a Medicare Advantage plan, your plan will determine any deductibles or coinsurance amounts. Plans can differ quite a bit, so check your summary of benefits. You can also request a summary of the expected cost before the procedure.
Does Medicare cover bariatric sleeve surgery? The Bottom Line
Medicare coverage for bariatric sleeve surgery is available on a regional basis. You will have to meet Medicare’s criteria for eligibility in order to have the procedure covered. There will be out-of-pocket costs, but Medicare Supplement insurance can help to pay them.
To compare Medicare plans for bariatric sleeve surgery today, enter your ZIP code below.