Medicare Bariatric Surgery Coverage
Medicare bariatric surgery has been approved, but certain caveats apply. Below we’ll review…
- What is Medicare and Medicaid?
- Bariatric surgery for people 65 and older – is it safe and effective?
- Caveats for Medicare to approve bariatric surgery
What is Medicare and Medicaid?
For those who are unfamiliar with this government-sponsored plan, Medicare is health insurance for people…
- 65 or older
- Under 65 with certain disabilities
- Any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
Medicaid is a state-run program for low-income individuals that pays Medicare premiums, deductibles and coinsurance for “Qualified Medicare Beneficiaries.” If you qualify, each state has its own requirements and may or may not pay for the surgery.
Bariatric Surgery for People 65 and Older
There are contradicting opinions about whether or not weight loss surgery is safe and effective for people 65 years of age and older…
- One 2009 study evaluated 100 patients over the age of 65 and found that bariatric surgery for seniors has similar benefits and no additional risks compared to patients under 65. In fact, they showed that morbidly obese patients over 65 actually have shorter hospital stays following bariatric surgery than younger patients. The same study showed that after two years older patients lost almost 76% of their excess weight.
- However, a 2006 study showed that seniors experience less weight loss and more complications than younger patients.
According
to the Centers for Medicare and Medicaid Services
(CMS):
“Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons it is an important option for some of our beneficiaries. While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries.”
Take a look at the CMS web site to read their entire opinion.
The takeaway is that bariatric surgery may be appropriate for people over 65 depending each individual’s situation. The only real way to find out is to get the direct opinion of good bariatric surgeon.
Caveats for Medicare to approve bariatric surgery
Medicare has determined that bariatric surgery is appropriate for the treatment of obesity as long as the patient has…
- A body mass index (BMI) greater than 35 (see our BMI Formula page for more on body mass index)
- At least one co-morbidity related to obesity
- Has documentation in their medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful
If all of the above apply, the surgery must be one of the following types…
- Gastric bypass surgery (open or laparoscopic)
- Lap band surgery (laparoscopic only)
- Biliopancreatic diversion with duodenal switch (BPD/DS) (open or laparoscopic)
To get approved, you’ll need to be referred by your primary care physician or other attending doctor (probably not just a self-referral to a bariatric surgeon). In their referral to a bariatric surgeon, your physician should refer to the obesity health problems that are expected to improve after surgery.
You’ll also need to choose a facility that meets the Centers for Medicare and Medicaid Services’ minimum facility standards and certification requirements for bariatric surgery. Click here to search their directory.
For additional research, search for your topic of interest...
Also see...
- Financing bariatric surgery without insurance
- How to find, interview and choose the best bariatric doctors
- Comparison of the types of bariatric surgery (remember, Medicare bariatric surgery patients are only approved for lap band, gastric bypass and duodenal switch surgery)
- Life after weight loss surgery
Back to Bariatric Surgery Source Home Page from Medicare Bariatric Surgery
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