- Medicare includes weight loss surgery if you meet certain criteria, such as having a BMI over 35.
- Medicare only covers certain types of weight loss.
- There will be some out-of-pocket costs for Covered Covered Services, such as deductions և co-payments depending on your specific situation և coverage.
Many Medicare beneficiaries choose weight loss surgery. Medicare will pay for some types of weight loss surgery if you meet certain eligibility criteria.
This article explains the details of Medicare coverage for weight loss surgery և other costs you need to know about.
Medicare coverage is divided into different parts, each of which covers different services. Here’s a look at what each part of Medicare covers when it comes to weight loss surgery.
Medicare Part A:
Part A covers hospital costs when you are inpatient. In addition to surgery, Part A will include your room, food, and medicine during your stay.
Medicare Part B:
Part B includes medical expenses such as preoperative doctor visits, obesity tests, nutrition therapy, and preoperative laboratory work. Part B can also pay for surgeon fees as well as facility costs if you have an outpatient (non-hospital) procedure.
Medicare Part C:
Medicare Part C, also known as the Medicare Advantage, is required to provide at least as much coverage as Medicare Parts A և B. Plans may include additional coverage to assist with postoperative recovery, such as Silver Sneakers programs. healthy food delivery. , և coverage of some prescription drugs.
Medicare Part D:
Medicare Part D is part of the Medicare prescription drug coverage. It should include all the necessary medications after surgery, such as pain or nausea medications.
Medigap plans cover out-of-pocket expenses that Medicare does not cover. Your Medigap policy can help cover the costs of deductible co-payments և co-insurance depending on your policy. You can get Medigap policy through a private health insurance company.
Often your surgeon will have a coordinator to discuss your financial capabilities for weight loss surgery. However, you can also contact Medicare or your Part C provider to make sure there are no additional costs associated with your procedure (for example, facility fees և anesthesia costs).
When it comes to weight loss surgery, there are three general approaches: insufficient, restrictive և insufficient և restrictive combination. The best approach for you depends on your weight, general health նպատակ weight loss goals.
Here is an overview of each approach.
This approach involves manipulating the stomach so that it can not absorb so many nutrients. One example of this approach is vertical layering of the stomach.
Vertical exfoliation of the stomach involves suturing the upper abdomen to limit its size. The process is rare.
Restrictive approaches reduce the size of the stomach so that it can not hold enough food. An example of this approach is called regulated gastric lavage.
In: Adjustable stomach flaking, a tape is placed around the stomach, reducing its capacity to 15 to 30 milliliters (ml). An adult stomach can usually hold about 1 liter (L).
Malabsstive + restrictive approach
Some procedures are both absorbent and restrictive. These include biliopancreatic diversion with a duodenal switch, gastric bypass roux-en-Y.
Biliopancreatic deviation with duodenal switch involves the removal of part of the stomach.
Roux-en-Y gastric bypass Reduces the size of the stomach to a small stomach pouch, which is usually about 30 ml.
Medicare does not include some weight loss treatments: surgical approaches. Treatments that may not be included include:
- stomach bladder
- intestinal bypass
- open, adjustable gastric lavage
- Open or laparoscopic gastrectomy
- open or laparoscopic vertical gastrectomy
- Extra fasting to treat obesity
- Obesity treatment only (for example, weight loss medical plans)
Medicare usually does not involve new or experimental procedures. Decontamination decisions are based on rigorous scientific data, which should prove that any new procedure is safe and effective, as is the medical necessity for its beneficiaries.
If you are not sure if Medicare will cover your weight loss procedure, contact Medicare (800-MEDICARE) or your plan provider immediately to determine if it is covered and how much it will cost.
Medicare will cover weight loss surgeries if your doctor recommends the procedure based on medical need. There are certain criteria that you must meet to prove that the procedure is medically necessary, such as:
- body mass index (BMI) that is at least 35 or higher
- at least one other condition associated with obesity, such as diabetes, high blood pressure, or hyperlipidemia
- Previously unsuccessful attempts at medically supervised treatments (e.g., nutritional counseling weight loss programs)
Your doctor may also have additional requirements for surgery. Because weight loss surgery is a life-changing procedure, you may be required to attend counseling sessions and / or psychiatric assessments.
Medicare considers each situation individually when approving bariatric surgery coverage. Your doctor must provide proof that you have met the Medicare requirements for weight loss surgery. Sometimes, the process can take up to several months before coverage is approved.
The average cost of weight loss surgery ranges from $ 15,000 to $ 25,000. Many different factors can affect this value, including length of stay in hospital, surgical approach, and medications needed.
Here is a summary of the costs associated with each part of Medicare:
- Part A. You must pay your deductible before hospital coverage starts. For 2020, this amount is $ 1,408. As long as you stay in your hospital for no more than 60 days, you should not incur additional costs under Part A.
- Part B. For outpatient expenses covered by Part B, you must also meet your deduction amount of $ 198 by 2020. Once you are satisfied with your reduction, you are responsible for 20% of the costs of your Medicare-approved treatment. Part B charges a monthly surcharge of $ 144.60.
- Part C. Tariffs for Part C plans vary depending on your provider և coverage, but they may have their own reductions, co-payments և co-insurance amounts. Contact your plan or check the benefits և coverage summary through your insurance provider’s website.
- Medigap. The purpose of these programs is to help cover your pocket money with Medicare coverage. Rates for these programs vary from company to company. You can compare և shopping for plans through the Medicare website.
Tips for maximum coverage
Follow these steps to get the most out of your plan.
- If you have a Medicare Advantage, check your plan to make sure your doctors and facility are online.
- If you have an original Medicare, make sure your providers are registered with Medicare. You can search the Medicare website using the participating provider tool.
If weight loss surgery is necessary, it can bring many different benefits to your overall health. This is one of the reasons Medicare helps to cover the cost of surgery.
According to a
- reduced risk of heart disease
- Improving glomerular filtration rate (measurement of renal function)
- Improving respiratory function
- Less metabolic problems, such as better blood sugar control
Medicare will include weight loss surgery, but you are responsible for some aspects of your care. If you have a Medicare Advantage, you may need to use a network մատակարար referral to a bariatric surgeon to begin the procedure.
Because the Medicare approval process involves a thorough review of each case, you can wait several months for your surgery to be covered by Medicare. You must first meet certain medical and աբ your surgeon requirements.
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