Avila Medicare Solutions

Obesity in Medicare coverage
Date of publication:

The Impact of Obesity on Medicare Coverage: What You Should Know

Obesity is a health condition that affects millions of people worldwide and can have serious consequences for quality of life. For Medicare beneficiaries, it is important to understand how this condition can impact your coverage and the services available for obesity management and treatment. Below, we will explore how Medicare addresses this growing issue and what services you can include in your plan to maintain your health.

Medicare and obesity-related services

Medicare recognizes obesity as a significant health problem and covers certain medical and preventive services to help beneficiaries manage this condition. These services include:

  • Evaluation of body mass index (BMI): Medicare covers regular BMI assessments to determine whether a person qualifies as obese and to assess his or her risk of developing related complications.
  • Intensive behavioral counseling for weight loss: Beneficiaries with a BMI of 30 or more have access to counseling sessions with medical professionals designed to encourage healthy habits, such as a balanced diet and regular physical activity.
  • Bariatric surgery: Medicare covers certain surgical procedures, such as gastric bypass and adjustable gastric banding, for those who meet specific criteria, including a high BMI and the presence of related medical conditions, such as type 2 diabetes.

Obesity-associated conditions and their coverage

Obesity not only affects body weight, but is also related to a variety of chronic diseases, such as:

  • Type 2 diabetes
  • Cardiovascular diseases
  • Hypertension
  • Degenerative joint diseases

Medicare provides coverage for the treatment of these associated conditions, as long as they are considered medically necessary. For example, drugs to control diabetes and therapies for cardiovascular disease may be covered under Medicare Part B or Part D.

Prevention and wellness: A key approach

Medicare also includes preventive services to reduce the risks associated with obesity. This includes health education programs, preventive screenings and access to fitness programs that may be available through some Medicare Advantage plans.

While these services are valuable, it is essential to review your plan specifications to fully understand what benefits are included and what out-of-pocket costs you may face.

Challenges and considerations for beneficiaries

It is important to note that coverage may vary by plan and location. In addition, some procedures, such as bariatric surgery, require prior authorizations and must meet strict criteria to be approved. Reviewing your plan and discussing options with your medical provider is crucial to avoid surprises.

How Avila Medicare Solutions can help you

Obesity and its associated conditions can pose significant challenges for Medicare beneficiaries. That's why expert support is key to maximizing your coverage and making informed decisions about your health.

At Avila Medicare SolutionsWe understand the complexities of Medicare plans and are here to help. If you have questions about how obesity in Medicare coverage may affect you or if you would like to explore plan options that better suit your needs, our team is here to help.

Contact us at 855-GO-AVILA to receive free, personalized counseling. We are committed to providing you with the support you need to make informed wellness decisions and get the most out of your Medicare plan benefits.

Do you have any doubts? Call us now.

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