Medicare covers some, but not all, weight loss surgery if a person meets several conditions.
In order for Medicare to cover weight loss surgery, a person must have:
The coverage is not 100%. The individual must pay deductibles, co-insurance և co-payments. Total costs depend on several factors.
Below we discuss weight loss surgery and then look at Medicare eligibility requirements. We also explain the types of procedures covered by Medicare, the costs, and the risks of surgery.
In this section we can use some terms that can be helpful in understanding when choosing the best insurance plan.
- Decreasing: This is an annual amount that a person has to spend out of pocket for a certain period of time before the insurer can finance his treatment.
- Co-insurance. This is the percentage of treatment costs that a person will need to self-finance. In the case of Medicare Part B, this is 20%.
- Co-payment: This is a fixed dollar that an insured person pays to receive certain treatment. For Medicare, this usually refers to prescription drugs.
Weight loss surgery is surgery that changes a person’s digestive system to help them lose weight. The operation works in two main ways.
First, it shrinks the stomach. This surgical change helps someone to get full faster after eating and drinking, which reduces the amount of food they can eat at the same time.
Second, it changes the small intestine. The small intestine is the part of the body that absorbs nutrients and calories from drinks and food. Procedures that remove food from the small intestine will lead to lower calorie intake.
Surgeons perform the procedures using one of two methods. The open method involves a large incision in the abdomen, while the laparoscopic method consists of several small incisions in the abdomen and the insertion of small surgical instruments through incisions.
Possible benefits of surgery include weight loss բարել improvement in obesity-related conditions such as high blood pressure և type 2 diabetes.
None of the surgeries can guarantee a certain amount of weight loss.
However, studies show that the average person loses 15–30% of their initial weight in any of the insects. People do not always lose as much weight as they want, some regain some of the weight they lost.
Medicare has determined that some weight loss procedures are reasonable և medically necessary for people who meet these criteria.
- They have a BMI of 35 or higher.
- They have previously had unsuccessful treatment for obesity.
- They have at least one of the diseases associated with obesity. These include high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, heart disease, stroke, osteoarthritis, respiratory problems, gallbladder disease, and some cancers.
Medicare involves three different procedures. Two of them work by “reducing the size of the stomach” by changing the small intestine. The third option is only to reduce the size of the stomach.
The procedures are:
Open և laparoscopic gastric bypass
This surgery involves gastric lavage, which greatly reduces its size. It also involves cutting a small part of the small intestine and attaching it to the stomach. The procedure, which consists of these two parts, causes the person to eat and absorb less food.
Open և laparoscopic biliopancreatic deviation with duodenal switch
This option consists of two separate surgeries. The first procedure cuts off part of the stomach, and the second straightens the food, bypassing most of the small intestine. This procedure leads to more weight loss, but it also carries a higher risk of surgery-related problems and malnutrition.
Laparoscopic adjustable gastric lavage
This surgery involves placing a band around the top of the stomach that forms a small pouch in the stomach. The band has a balloon inside that contains saline solution. The surgeon can adjust the size of the bag by removing or injecting the solution through a port under the human skin.
Because the evidence is insufficient to show that some weight loss procedures are reasonably necessary, Medical does not cover them. These include the surgeries listed, some of which have caused security issues.
- Gastroplasty with open laparoscopic vertical band, which is the insertion of a staple ելու tape to create a very small stomach.
- Open laparoscopic gastrectomy, which is the removal of most of the stomach.
- Adjustable open stomach zoning, which is similar to the laparoscopic version, except that surgeons make it through a large incision in the abdomen.
- Stomach bladder surgery, which is the placement of a device in the stomach to reduce its capacity.
- Intestinal bypass, which is a surgery that bypasses most of the small intestine.
According to the National Institute of Diabetes and Digestive Kidney Disease, weight loss surgeries will cost between $ 15,000 and $ 25,000.
It is difficult to estimate the part of this amount that a person has to pay, as it is not possible to determine the required services in advance. Original Medicare insures those who meet eligibility requirements but apply deductibles, co-insurance և co-payments.
Total costs depend on the type of surgery, among other factors, including:
- whether the individual has met his or her deductible
- Does the person have problems with the surgery?
- if the procedures are performed on an inpatient or outpatient basis
A person can check if they have met their deductions through their Medicare portal or by referring to the Medicare notice they should receive every 3 months.
The person with the original Medicare can expect the following costs:
- Part A reduction by $ 1,408
- Part B reduction: $ 198
- Part B co-insurance 20%
If one of the original Medicare owners has a Medigap plan, which is a supplement to Medicare, it will pay some or all of the unpaid costs.
It is more difficult for a person with Medicare Advantage to estimate the costs because the deductions, co-payments և co-insurance are different for each plan. An individual may need to choose from network providers.
If a doctor prescribes medication to someone who has had surgery, Medicare can help in two ways: Through Part D, which is prescription drug coverage available to all through the original Medicare, or through the Medicare Advantage, instead of the original Medicare, if the plan includes prescription coverage.
Some side effects may occur immediately after surgery, while others may occur later. Immediate side effects may include:
- leakage from the operation site
- Blood clots in the legs that can move to the heart or lungs
Problems with surgery rarely lead to death, but it is always possible.
The following side effects may occur:
- A person may not be able to absorb nutrients well, which can lead to health conditions such as anemia and osteoporosis.
- Rapid weight loss can lead to gallstones.
- The person may experience stiffness, narrowing of the stomach or intestinal tissue, which may cause vomiting, nausea, or swallowing problems.
- Bypass surgery can change the way a body absorbs alcohol, which can lead to alcohol-related problems.
Medicare includes certain weight loss surgeries if a person meets several conditions. However, the person undergoing surgery is responsible for deductions, co-payments and co-insurance.
Weight loss surgeries that include Medicare reduce stomach size, straighten food from the small intestine, or both. Processes have side effects and risks, some of which are serious.
People who are considering one of the surgeries may want to discuss the possible benefits and risks with their doctor.
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