Did you know that you can use your Medicare coverage to fight obesity? Your coverage includes obesity screenings, counseling sessions, nutritionists, and qualified dietitians. It may even include gym membership discounts. If you think eating well and exercising is too expensive, think again: your Medicare plan can cover it!
Medicare Part B Weight Management Services
Since obesity is classified as a disease, Medicare Part B covers it like any other ailment. It all starts with your “Welcome to Medicare” annual wellness visit when you first enroll, and it continues with your yearly wellness visits. At your appointments, your doctor should check your height, weight, blood pressure, and BMI – all things that can help your doctor diagnose you with obesity and provide proper treatment. These appointments do not require cost-sharing.
If your doctor considers you at risk for obesity, you may be eligible for preventative counseling and even appointments with a nutritionist. Medicare Part B can cover medically necessary counseling and nutrition therapy.
Obesity commonly leads to heart disease. Medicare Part B covers cardiac rehabilitation (exercise, education, and counseling) for those who have had a heart attack, heart failure, or a related surgery.
Nutritionists & Dietitians
Your doctor may recommend that you see a nutritionist or dietician.
Be careful when choosing a nutritionist or dietitian, because Medicare does not cover all of them. For Part B to cover this service, you must medically require it, and the nutritionist or dietitian must accept Medicare assignment. Medicare only covers trained nutritionists under Part B as MNT (medical nutrition therapy). Any patient who has diabetes, kidney disease, or has had a kidney transplant is eligible based on medical need.
Obesity Screenings & Counseling
As long as you have Medicare Part B and have a BMI (body mass index) of 30 or higher, you are eligible for obesity screenings and counseling. The National Heart, Lung, and Blood Institute has a free BMI calculator on its website, but a doctor’s screening will be much more accurate. Your BMI is the percentage of your bodyweight that is made up of fat. Remember that some fat is healthy – you are not aiming for a BMI of zero. A healthy BMI is between 18 and 25. Lower than 18 is too little, 25-30 is a bit high, and above 30 is obese.
When you do get your free obesity screening, you might consider behavioral counseling for body fat loss. Your primary physician should offer their own counseling. If not, they might recommend another Medicare-covered service.
Original Medicare (Part A and Part B) does not cover gym memberships or fitness programs. However, additional coverage from a unique Medicare Advantage or Medicare Supplement plan may include gym membership or fitness center discounts. These are usually offered through major Medicare fitness programs such as SilverSneakers and Silver & Fit. Plans with these benefits are not available in every county. Look over your plan or speak with your agent if you aren’t sure about fitness coverage in your Medicare plan.
Obesity Is a Disease
In 2013, the American Medical Association officially started recognizing obesity as a disease. As such, with a BMI of 30 or higher, you can qualify for “obesity behavioral therapy.
The disease affects approximately ⅓ of Americans, and this recognition allows it to be taken more seriously in the medical community and increase research funding. The classification also helps decrease the stigma involved with obesity. It is a commonplace lie that obesity is merely the result of overeating and a lack of exercise. Some people lack the mental strength to control their eating habits and others are incapable of exercising for one reason or another. Saying that obesity is a disease opens the door for counseling and physical therapy as a form of treatment.
Obesity is a common disease in the senior citizen community due to a reduction in physical activity and a lack of access to good nutrition. Additionally, other common senior conditions like heart disease, diabetes, and physical impairments can make it harder to focus on nutrition and exercise. That’s why it’s so important to use your Medicare coverage for healthy eating, exercise, and weight loss.
Does Medicare Cover Weight Loss Surgery/Bariatric Surgery?
Medicare Part B covers bariatric surgeries such as gastric bypass surgery and laparoscopic banding surgery (LAP-BAND). However, you must meet certain criteria. For example, your doctor must determine that Medicare weight loss surgery is necessary.
You may qualify if you have a body mass index (BMI) greater than 35 and you have at least one obesity-related comorbidity or health problem such as diabetes, hypertension, or high cholesterol. You might also qualify for weight loss surgery if you’ve struggled with obesity for five years or more.
Medicare does NOT cover cosmetic surgeries, such as excess skin removal for weight loss.
Medicare for Diabetes and Weight Loss
Obesity can put you at a higher risk of developing diabetes. You can use your Medicare coverage to help prevent both obesity AND diabetes.
Medicare Part B covers diabetes self-management training (DSMT), blood sugar monitors, blood test strips, lancets devices, lancets, therapeutic shoes or inserts, and external insulin pumps.*
Additionally, Medicare can cover your participation in the 16-session Diabetes Prevention Program if you:
- Have a BMI over 25 (23 if you are Asian)
- Have never been diagnosed with either diabetes or ESRD
- Have not participated in this program before
- Have a hemoglobin A1c test result of 5.7-6.4%, a fasting plasma glucose result of 110-125 mg/dL, or a two-hour plasma glucose result of 140-199 mg/dL (test results must be from the past 12 months)
*There may be some coverage limitations.
What Else Does Medicare Cover, and Do I Qualify?
Medicare Part A covers hospital stays, and Medicare Part B covers physician services. If you are over the age of 65, you automatically qualify for Medicare coverage. You can also qualify by receiving SSDI (Social Security Disability Income) for 25 months or more or by being diagnosed with either ALS (Lou Gehrig’s Disease) or ESRD. Most people will get premium-free Part A but will have to pay a monthly premium for Part B.
To add more to your Medicare plan, the best option is to enroll in a MAPD, or Medicare Advantage Prescription Drug plan. These plans include everything that Part A and Part B covers plus prescription drug coverage and other benefits like dental, vision, and fitness programs like SilverSneakers and Silver & Fit.
We have benefits advisors in 38 states that can help you select the best Medicare Advantage Prescription Drug plan for your needs. Some people may even be able to get a MAPD plan with a $0 premium! To find out more, chat with us, send us a message, or give us a call at 833-438-3676.
This post was originally posted on June 22, 2017 by Anastasia Iliou, and updated on July 8, 2019, by Troy Frink.