Does Medicare offer coverage for weight loss programs?
While Medicare offers a variety of preventive services to help you attain a healthy weight, it generally doesnâ€™t cover weight loss services, programs, or medications. These include:
- services such as meal delivery for weight loss
- programs such as Nutrisystem or Weight Watchers
- FDA-approved diet pills or medications
However, there are some cases when original Medicare will provide preventive weight loss screenings and nutrition counseling â€” as long as you meet the eligibility criteria.
In addition, some Medicare Advantage (Part C) plans offer additional health and wellness services, like fitness programs and gym memberships.
Letâ€™s dive into exactly what programs and services Medicare covers that may help with weight loss.
What weight loss services are covered by Medicare?
Medicare doesnâ€™t offer weight loss services for all enrollees unless itâ€™s necessary for a medical procedure, such as to prepare for bariatric surgery, or as part of your preventive care.
Letâ€™s go over the eligibility rules for each Medicare-covered service for weight loss.
Obesity screenings and counseling
If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling.
These preventive services must be performed by your doctor or primary care physician in a doctorâ€™s office or primary care setting. They include:
- obesity screening
- dietary assessment
- nutrition counseling
Obesity screenings and behavioral counseling are considered preventive services, which are covered under Medicare Part B. Part B is one part of original Medicare.
Most of these services will cost you nothing out of pocket as long as youâ€™ve met your Part B deductible for the year.
Medical nutrition therapy (MNT) is often used to treat and manage certain health conditions, such as diabetes or kidney disease. This type of therapy includes:
- nutrition and lifestyle assessment
- nutritional therapy sessions
- lifestyle management
- follow-up visits
Medicare will cover MNT if you have either of the conditions mentioned above or have had a kidney transplant within the last 36 months. Dialysis patients also receive MNT as part of standard care.
MNT is considered preventive, so thereâ€™s no out-of-pocket cost for these services. However, your doctor will need to refer you to a registered dietitian for counseling.
Original Medicare doesnâ€™t cover gym memberships or fitness programs.
However, some Medicare Advantage plans offer health and wellness benefits that cover these types of services. These may include:
- SilverSneakers: one of the most popular fitness programs for adults age 65 and older
- Renew Active: a program by UnitedHealthcare that covers gym memberships and other health and wellness programs and events
- Silver&Fit: another fitness program that offers nationwide services both in person and online
Before you enroll in a Medicare Advantage plan, check what kind of coverage it offers for these programs. Plans that include this type of coverage might have additional costs, depending on the company.
Again, if you have original Medicare (parts A and B), you wonâ€™t be covered for any of programs. Youâ€™ll pay the full price of these services out of pocket.
Weight loss surgery
In some cases, bariatric surgery may be medically necessary for extreme weight loss. While Medicare doesnâ€™t cover weight loss surgeries for appearance reasons, it will cover bariatric surgery if you meet the following criteria:
- a BMI of 35 or higher
- at least one underlying health condition related to obesity
- previous unsuccessful medical attempts at weight loss
Medicare coverage of these procedures includes both malabsorptive and restrictive bariatric procedures, such as:
- Roux-en-Y gastric bypass
- biliopancreatic diversion with duodenal switch
- adjustable gastric banding
- sleeve gastrectomy
- vertical gastric banding
Medicare will cover bariatric surgery if you meet the eligibility criteria listed above. However, youâ€™ll owe the standard Medicare plan costs for the procedure, which may include:
- any deductibles you havenâ€™t already paid
- copayments for doctorâ€™s and specialistâ€™s visits
- coinsurance for any procedures
What isnâ€™t covered?
Most weight loss interventions, unless preventive or medically necessary, arenâ€™t covered by Medicare. Noncovered weight loss interventions may include:
- weight loss programs such as Weight Watchers or Nutrisystem
- weight loss procedures purely for aesthetic purposes, such as liposuction
- weight loss medications, including FDA-approved â€œdiet pillsâ€
Although Medicare does cover most bariatric surgery procedures, it doesnâ€™t cover the following bariatric procedures:
- gastric balloon
- intestinal bypass
- open adjustable gastric banding
- open sleeve gastrectomy
- laparoscopic sleeve gastrectomy
- open vertical banded gastroplasty
- laparoscopic vertical banded gastroplasty
If you enroll in any of these noncovered programs or undergo any of these services, you may end up paying the full cost out of pocket.
These costs can range from less than $100 per month for programs like Weight Watchers, to between $2,000 to $4,000 for procedures like liposuction.
How can I get the most coverage for weight loss management?
Medicare enrollees who are interested in extra health and wellness coverage for weight loss should compare Medicare Advantage plans in their area.
Most Medicare Advantage plans offer additional coverage beyond what original Medicare covers â€” especially when it comes to perks such as fitness programs and gym memberships.
If you meet the coverage criteria listed above for weight loss surgery, you donâ€™t need to enroll in a Medicare Advantage plan to be covered for these services. Theyâ€™ll be covered under your original Medicare plan.
However, if you would like additional long-term support after surgery, Medicare Advantage plans may offer these health and wellness perks.
Even if your Medicare plan doesnâ€™t cover the weight loss services youâ€™re interested in, there are some dietary and lifestyle changes you can make on your own, including:
- Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, and healthy fats. Focus on lean protein and eat red and processed meats in moderation.
- Enjoy refined carbohydrates, such as sweets and soda, in moderation. These foods have a low nutritional value and often take the place of more nutritious options.
- Drink water often and make it your primary drink throughout the day. Soda, alcohol, and other beverages are fine in moderation but can add extra calories.
- Find a diet that works for you in the long term and avoid overly restrictive or dangerous fad diets. Always reach out to your doctor first before making any major dietary changes.
Weight loss programs can offer a great support system to help you meet your weight loss goals. However, original Medicare wonâ€™t cover most weight loss services unless theyâ€™re preventive or your doctor has decided that theyâ€™re medically necessary for your situation.
If you want Medicare coverage for these extra services, such as gym memberships and fitness programs, youâ€™ll need to find a Medicare Advantage plan that meets your needs.
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