Does Medicare Cover Weight Loss Medication?
- Medicare does not typically cover weight loss medication, but Medicare does cover a variety of weight loss services. Learn more about the Medicare benefits that can help you lose weight.
Original Medicare (Part A and Part B) does not cover weight loss medication. Medicare Part D Prescription Drug plans and Medicare Advantage (Medicare Part C) plans typically do not cover weight loss pills either.
In some cases, prescription drugs that are needed in preparation for or following a covered weight loss surgery may be covered by Medicare. If you’re having a weight loss surgery that Medicare will cover, ask your doctor about whether Medicare will cover any prescription drugs you may need after the surgery.
While Medicare doesn’t cover weight loss pills, Medicare coverage for weight loss programs and weight loss surgery includes bariatric surgery and a variety of services designed to help beneficiaries lose weight and manage the symptoms of excess weight.
Medicare Covers Obesity Behavioral Therapy
Medicare Part B covers obesity screenings and behavioral counseling.
To qualify for coverage, you must have a body mass index (BMI) of 30 or higher, and you must receive obesity counseling from a Medicare-approved doctor or other primary care practitioner in a primary care setting. If you meet the qualifications for Medicare coverage, you will pay nothing for the service.
Your initial BMI screening would be followed by behavioral therapy sessions that include a dietary assessment and counseling for help losing weight through diet and exercise.
Because Medicare Advantage plans are required by law to provide the same basic benefits as Medicare Part A and Part B, obesity screenings and counseling sessions are covered by Medicare Advantage plans too.
Medicare Covers Bariatric Surgery Such as Gastric Bypass
Medicare covers a few different types of bariatric surgeries, each of which are designed to help patients lose weight. Covered procedures include gastric bypass, lap band, duodenal switch and sleeve gastrectomy.
The amount that Medicare pays for bariatric surgery depends on whether the procedure is performed as an inpatient or outpatient. Depending on where the surgery takes place, it may be covered by Medicare Part A or Part B. Medicare Advantage plans will provide at least the same coverage as they would be covered by Part A and Part B.
Medicare Part A pays for inpatient hospital costs, including your hospital stay costs such as your room and your food. Medicare Part B covers outpatient care, such as visits to your primary care doctor or an outpatient surgery center.
Medicare Covers Diabetes Prevention Programs
Medicare Part B and Medicare Advantage plans cover a diabetes prevention program. Medicare will cover your one-time participation in the program if you meet the following conditions:
- You have a body mass index of 25 or more (23 or more if you’re of Asian descent)
- You’ve never been diagnosed with type 1 or type 2 diabetes or End-Stage Renal Disease (ESRD)
- Your hemoglobin and plasma glucose test results are within a specified range
If the above conditions apply and you have never previously participated in the weight loss program, you will pay nothing for the program.
The Medicare weight loss program consists of 16 core sessions offered in a group setting over a 6-month period. The sessions include coaching on exercise habits and other behavioral changes, and they include support from other professionals and participants.
After completing the initial sessions, you can receive six more months of follow-up sessions and 12 more months of ongoing maintenance sessions if you meet certain weight loss and attendance goals.
Medicare Covers Nutrition Therapy
Medicare Part B and Medicare Advantage plans cover nutrition therapy for beneficiaries with diabetes or kidney disease or those who have received a kidney transplant in the last 36 months. You will pay nothing for Medicare nutrition therapy if you qualify for coverage.
Medicare nutrition therapy includes a nutrition and lifestyle assessment, individual or group nutritional therapy sessions, assistance with managing diabetes and follow-up visits to monitor your progress.
Medicare Covers Yearly Wellness Visits
Each new Medicare Part B beneficiary receives a “Welcome to Medicare” preventive checkup with a primary doctor.
Each year thereafter, Medicare Part B and Medicare Advantage plans provide full coverage for an annual “Wellness” visit where you and your doctor will discuss your weight, diet, lifestyle and other health issues.
Some Medicare Advantage Plans Offer SilverSneakers or Silver and Fit Memberships
Many Medicare Advantage plans cover the cost of membership to the SilverSneakers program or to a similar health program called Silver&Fit.
SilverSneakers is a fitness program designed specifically for senior adults that can be found at thousands of gyms across America. Silver&Fit is a similar program that offers seniors organized fitness classes, training equipment at gyms and DVDs to help seniors stay active at home.
You may be able to find a Medicare Advantage plan in your area that offers free fitness benefits and comes with $0 monthly premiums. To learn more, compare plans for free online or call to speak with a licensed insurance agent who can help you explore the available plans and walk you through the enrollment process if you decide on a plan that's right for you.
For More Information
For more information about what Medicare covers and what your coverage options are for weight loss services, you can call 1-800-MEDICARE (1-800-633-4227). If you are enrolled in a Medicare Advantage plan, you may contact your plan directly.