Medicare and Bariatric Surgery Coverage: Everything You Need To Know

At Avila Medicare Solutions, we understand that bariatric surgery can be a vital option to improve the health and quality of life for many seniors struggling with obesity. Medicare offers coverage for these types of procedures under certain conditions. In this article, we will explore how Medicare and bariatric surgery coverage works, and how you can benefit from these services.

What is Bariatric Surgery?

Bariatric surgery includes several types of procedures designed to help you lose weight by making changes to the digestive system. Among the most common types are:

• Gastric Bypass
• Adjustable Gastric Band
• Sleeve Gastrectomy
• Biliopancreatic Diversion with Duodenal Switching

These procedures can help reduce the risks associated with obesity, such as type 2 diabetes, hypertension and heart disease.

How does Medicare cover Bariatric Surgery?

Medicare may cover bariatric surgery if you meet certain criteria. The following are the requirements and the process for obtaining this coverage.

Eligibility Criteria

For Medicare to cover bariatric surgery, you must:

• Have a body mass index (BMI) of 35 or more.
• Suffer from at least one obesity-related comorbidity, such as type 2 diabetes, severe sleep apnea, or heart disease.
• Previous unsuccessful attempts to lose weight through diet and exercise.

2. Medical Evaluation and Referral

You need to be evaluated by a Medicare physician who determines that bariatric surgery is medically necessary. This process generally includes:

• A complete evaluation of your medical history.
• Examinations and tests to determine your fitness for surgery.
• Documentation of previous attempts to lose weight.

Out-of-pocket expenses

Although Medicare covers many services, beneficiaries may still face out-of-pocket expenses, such as deductibles, copayments and coinsurance. These costs can vary depending on the specific Medicare plan and services used. It is important to plan and budget for these expenses to avoid financial surprises.

What Costs Are Covered by Medicare?

Medicare Part A covers inpatient hospital costs, while Medicare Part B covers medically necessary services, such as doctor visits and pre-operative tests. However, you may have to pay certain out-of-pocket costs, such as deductibles, copayments and coinsurance.

Hospitalization (Part A)

• Hospital DeductibleYou pay a deductible for each benefit period.
• CoinsuranceAfter the first 60 days of hospitalization, you may have to pay a daily coinsurance.

Medical Services (Part B)

• Annual DeductibleYou must pay the annual Part B deductible.
• CoinsuranceMedicare covers 80% of the approved cost, and you pay the remaining 20%.

Additional Medicare Advantage Benefits

Medicare Advantage (Part C) plans may offer additional benefits that are not covered by Original Medicare, such as fitness programs and nutritional counseling. It is important to review the details of your plan to understand what additional benefits you may have.

Maximizing Your Profits

1. Review Your Coverage Annually

During the open enrollment period, review your Medicare coverage to make sure your current plan is still the best option for you.

2. Take advantage of Support Services

Use the support services offered by Medicare, such as nutritional counseling and fitness programs, to maximize the benefits of your bariatric surgery.

3. Consult with a Medicare Counselor

At Avila Medicare Solutions, we offer free, expert advice to help you navigate the bariatric surgery coverage process and make sure you meet all the requirements.

If you have questions about Medicare and bariatric surgery coverage, or need help understanding your options, don't hesitate to contact us. Visit our web site o call us directly to schedule a free consultation. Our team of experts is here to provide you with the information and support you need to make informed decisions about your health.

Let us be your partner in managing your health and optimizing your Medicare coverage. At Avila Medicare Solutions, we are here to help you every step of the way.