As you age, maintaining a healthy weight becomes increasingly important for overall wellness. Being obese can lead to serious health issues and chronic diseases, especially in seniors. These can include heart disease, sleep apnea, arthritis, and type 2 diabetes.
For those suffering from obesity and any of these related diseases, losing weight and keeping it off can be crucial for improving their health. With a focus on preventing disease and improving health outcomes in seniors, Medicare covers certain weight loss-related services, based on a patient’s health and doctor’s diagnosis.
How do you know what weight loss treatments are covered and if you’re eligible? Just keep reading! In this blog, we break down the types of weight loss services and treatments covered by Medicare, so you can understand and navigate the options available to you.
Does Medicare Cover Weight Loss Programs?
Medicare Part B health insurance provides coverage for some weight loss programs to beneficiaries meeting certain health eligibility requirements. Specifically, the “programs” covered are wellness screenings, obesity counseling and nutrition therapies. Coverage is based on a patient’s health and weight (body mass index, or BMI, of 30 or higher) with the goal of helping individuals manage health conditions through lifestyle changes.
Here’s the weight loss and weight management initiatives Medicare covers and how they work together:
Wellness Visits
Your weight loss journey may start with your Initial Preventive Physical Exam, also known as a Welcome to Medicare Preventive Visit. During this one-time visit within the first 12 months of enrolling in Medicare Part B your healthcare provider will review your medical history, check your status of recommended preventative screenings and any needed preventive care appointments, and assess your overall health, including taking height, weight, and blood pressure measurements and calculating your BMI. They’ll then give you recommendations or referrals for other care as needed, such as appropriate weight loss steps.
Your Annual Wellness Visits are 100% covered every 12 months and are your yearly opportunity to get a checkup with your doctor and review your overall health and assess risk factors, including weight and obesity. Your healthcare provider will provide weight management advice and recommend any changes to your personalized prevention plan.
Obesity Counseling
This program takes a behavioral therapy approach with intensive counseling sessions that aim to promote weight loss by encouraging dietary changes, increased physical activity, and lifestyle modifications. If your body mass index (BMI) is 30 or higher, Medicare covers obesity counseling from qualified providers in a medical setting. Medicare coverage includes one face-to-face visit every week for the first month, followed by a bi-weekly visit for the next five months. If you lose at least 6.6 pounds (three kilograms) during this period, additional monthly sessions may be covered for up to a year.
NutritionTherapy Services
If you’re suffering from diabetes or kidney disease, Medicare Part B also covers Medical Nutrition Therapy. This involves counseling sessions with a registered dietitian or nutrition professional to help manage your condition through proper nutrition, which often includes weight loss advice.
All these weight loss services must come from a Medicare-approved healthcare provider in order for Medicare Part B to cover them. Medicare does not cover commercial weight loss or diet programs, like Weight Watchers, Nutrisystem, or similar programs.
Does Medicare Cover Weight Loss Surgery?
While weight loss programs like counseling and nutrition services are designed to help you lose weight through a healthy lifestyle, these may not work for every patient. For those struggling with severe obesity that hasn’t responded to other treatments, Medicare does cover weight loss surgery, also known as bariatric surgery, with strict guidelines about who qualifies.
For Medicare to cover your bariatric surgery, it must be deemed medically necessary by your doctor with the following conditions:
- BMI of 35 or higher, categorizing you as severely obese.
- At least one obesity-related condition, such as type 2 diabetes, heart disease, or sleep apnea.
- Documented history of weight loss attempts—meaning you must have attempted other weight loss treatments, such as diet and exercise, and these outcomes must be documented with a physician before surgery is approved.
If approved and eligible, Medicare covers these bariatric surgeries and procedures:
- Gastric bypass
- Lap-band surgery
- Sleeve gastrectomy
How much you’ll pay out of pocket versus how much of your surgery is covered by Medicare all depends on the type of surgery you have and where. If it’s inpatient and you’re admitted to the hospital, it will fall under your Medicare Part A hospitalization deductible. For doctor and outpatient care, it will fall under Medicare Part B. Even with Medicare covering your bariatric surgery, you may still have to pay out of pocket costs, such as deductibles, copayments, or coinsurance.
Does Medicare Cover Weight Loss Medications?
Medicare Part D plans provide your prescription drug coverage but do not cover medications prescribed solely for weight loss. However, Medicare does cover medications prescribed to help treat and manage related health conditions, like diabetes, that may also assist in weight loss.
Examples of this are GLP-1 medications, or glucagon-like peptide-1 receptor agonists. You may know them by their brand names like Trulicity, Ozempic, and Wegovy—the game-changing weight loss drugs even celebrities are using. These medications are intended to treat type 2 diabetes and obesity by mimicking the hormone in the body that helps control blood glucose levels, insulin production, and appetite, promoting a feeling of fullness. This appetite suppression is what has made these medications popular for weight loss, even for those without diabetes.
In March 2024, Medicare added Wegovy to Part D plan coverage after the FDA expanded the approval of the drug for use to reduce the risk of heart attack and/or stroke for patients suffering from cardiovascular disease and obesity. Medicare covers the drug only for those patients diagnosed with heart disease and as overweight/obese.
Navigate Medicare Coverage with Expert Support
Maintaining a healthy weight can ensure a healthier you. When you know and understand your Medicare coverage options, you can make informed plan decisions that support your weight loss strategies and achieve your healthy weight goals. Wandacare’s team of licensed Medicare advisors can help determine your eligibility based on your unique medical needs.
