Bariatric surgery is a powerful and effective tool in helping people lose weight. Most individuals who undergo bariatric surgery safely lose a significant amount of excess weight within a year.
Medicare-approved bariatric surgery is available today due to its high success rate and low-risk potential, even for older patients. If you qualify for Medicare in 2021, you can mitigate a large portion of costs associated with weight loss surgery.
If you’re considering weight-loss surgery, read on to learn what you need to know about Medicare coverage.
Pre-Approval Requirements for Medicare
Medicare will cover a large portion of your bariatric surgery costs if you meet the pre-approval requirements. These requirements include:
- A letter from your doctor recommending weight loss surgery.
- Documented proof you’ve been struggling with obesity for the last five years.
- Your obesity is not the cause of health issues that can be treated.
- Body mass index (BMI) of 35 or more.
- You have undergone thyroid, adrenal, or pituitary tests, and the results were positive.
- You have passed a psychological evaluation.
- You must have one co-morbidity factor, a serious illness that’s directly related to your weight. This can include diabetes, high blood pressure, or sleep apnea (amongst other conditions).
During your initial consultation at Olde Del Mar Surgical, we will examine your medical history and evaluate your current medical state. The information we gather will help determine which bariatric procedure will likely be safest and most successful in helping you lose weight.
If you meet all necessary criteria for the procedure, Medicare will likely approve the procedure and pay the majority of the cost. Dr. Bhoyrul is a Medicare-approved physician, and in most cases, a referral from your primary care physician will not be necessary.
Are All Bariatric Facilities Covered By Medicare?
In the past, Medicare would only provide coverage for facilities accredited as a Bariatric Center of Excellence. However, this is no longer the case, allowing for a wider variety of weight loss facilities to provide Medicare coverage for bariatric surgery.
Despite this, you should always reach out to Medicare-approved physicians and accredited facilities, like Olde Del Mar Surgical, for the best level of care.
Qualified facilities require that bariatric surgeons perform a minimum number of surgeries every year to maintain their accreditation. This will provide peace of mind that you’ll be working with experienced professionals.
Which Bariatric Surgeries Are Covered by Medicare?
Medicare coverage includes a wide range of weight-loss surgeries. These include:
- Duodenal Switch: In this surgery, 70% of the stomach is removed instead of 85% of the stomach with gastric sleeve surgery. Duodenal Switch surgery is relatively new, which means healthcare providers are not as familiar with this procedure as they are with others.
- Lap Band Surgery: Lap band surgery involves placing a thin, adjustable ring (also known as a gastric band) around the upper stomach. The gastric band creates a smaller stomach, which results in feeling fuller with a much smaller amount of food.
- Gastric Bypass: Gastric bypass involves changing the way your stomach and small intestine digest food. This results in restricting the amount of food your stomach can hold, leading to fewer calories being ingested.
- Sleeve Gastrectomy: During sleeve gastrectomy, around 80% of the stomach is removed. This leaves a tube-shaped stomach that is significantly smaller, restricting the amount of food you can consume as a result. Note: this procedure is only(covered on a region by region basis. Check with your bariatric surgeon to ensure Medicare will cover this surgery.
- Lap Band Fills: Lap band fills are also covered following gastric band surgery. The doctor uses a needle to insert it into the port located on your abdominal wall with lap band fills.
What Type of Medicare Do You Need?
While there is a range of coverage types that fall under the umbrella of Medicare, there are two, in particular, you need to be aware of when considering bariatric surgery.
Part A (Hospital Insurance)
In most instances, you will be enrolled automatically into Part A unless you explicitly state otherwise.
Part A Medicare insurance provides coverage for skilled nursing facilities, inpatient hospital care, hospice, and home health services. Part A will generally be offered at no cost to you as long as you or your spouse paid taxes on Medicare at any point during your working life.
Part B (Medical Insurance)
Part B covers outpatient care such as home health, visits to the doctor’s office, and certain types of preventative services. Recipients are automatically entered into Plan B if they qualify for Railroad Retirement Board benefits and Social Security.
Other aspects of Medicare, such as Part C (Medicare Advantage Program) and Part D (prescription drug coverage), provide additional benefits to those who qualify. Visit the Medicare website to learn more.
How Much Will You Have to Pay?
Ultimately, Medicare Part A will cover all inpatient services while hospitalized, while Medicare Part B will cover surgical aftercare and outpatient surgery.
Both Part A and Part B typically cover 80% of the total expense, meaning the Medicare beneficiary will have to cover the remaining 20% out of pocket. This cost will vary depending on the frequency in which you visit your bariatric surgeon.
Ultimately, it can be hard to know the exact costs of bariatric surgery upfront because you won’t know exactly what type of treatment you need until you discuss it with your healthcare provider.
To get the most accurate estimate of what Medicard Medicaid services will cover, we recommend asking the following questions:
- How much will I have to pay for bariatric surgery and aftercare?
- Will I have a choice between an inpatient and outpatient center?
- Am I considered an inpatient or outpatient?
- What does my Medicaid account cover?
Follow-Up Care Coverage
Follow-up care services involve helping patients get the best possible results from their bariatric surgery through various activities that include progress tracking, daily health monitoring, and post-surgery support.
Follow-up care is critical to helping patients obtain the best possible results from their surgery. Medicare also covers these services.
Our follow-up care includes daily health monitoring, progress tracking, and post-surgery support, all provided by the skilled care team at Olde Del Mar Surgical.
Medicare typically covers post-surgical treatment for a Medicare-approved procedure. The staff can help you get the maximum level of care that your Medicare benefits offer.
Working with Medicare To Cover Bariatric Surgery
Understanding the protocols around federal government gastric bypass surgery can be tough. It can also be challenging navigating the Centers for Medicare & Medicaid Services website. That’s why the caring staff at Olde Del Mar Surgical is here to help. Our team is seasoned in walking patients through all that is involved in Medicare-approved bariatric surgery.
We can guide you through the process, help you avoid any pitfalls, and double-check to make sure paperwork is properly completed. Our experienced staff will ensure a smooth process and make sure Medicare properly covers your surgery.
Schedule an Appointment Today
Please schedule an appointment with Dr. Bhoyrul at Olde Del Mar Medical today to discuss the options available to you. We would also love to offer $100 off your surgery if you schedule your initial consultation appointment within one week of reaching out.