Does Medicare Cover Bariatric Surgery?
Are you struggling against obesity and willing to experience bariatric surgery in your retirement? If yes, your primary question would be, ‘does Medicare cover bariatric surgery?
The good news is that it does.
Here is what you need to know about the surgery and its coverage by Medicare.
Types of Bariatric Surgeries
Bariatric surgeries change the structure of the digestive system to limit food consumption by the patient. The four most common types of bariatric surgery include:
Gastric bypass surgery, which creates a new stomach and bypasses a small portion of the small intestine;
Gastric banding, which uses an adjustable gastric band around the upper portion of stomach;
Gastric sleeve surgery removes 85% of the stomach; and
Biliopancreatic diversion removes 70% of the stomach.
Eligibility for Medicare Coverage
Once the patient meets the criteria for bariatric surgery, Medicare coverage kicks in when the patient:
Presents a history of one serious attempt at weight loss program,
Passes a psychological evaluation, and
Has undergone Thyroid, Adrenal, and Pituitary blood tests.
The patient can only start the approval process for this coverage using a referral or recommendation from doctors.
Another consideration of approval is the healthcare practitioner. The enrollee must search for a facility which is meet standards specified by Centers for Medicare and Medicaid Services (CMS). Also, these facilities should also be included in the network of your insurance provider if you are enrolled in Part C.
Once your eligibility is confirmed based on your health history and you have acquired the relevant documents and selected the healthcare facility, you can get coverage under Medicare. Under this coverage, Medicare Part B will cover 80% of service and supplies costs. Your out-of-pocket costs include 20% of part B coinsurance and part A and B deductibles.
If you are enrolled in Part C, your surgery costs will include surgery copayment and hospital stay copayment.
So, does Medicare cover bariatric surgery? The simple answer to this question is yes, it does. You can reduce the out-of-pocket cost of surgery to surgery copayment and hospital stay copayment if you are covered by part C.
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