Weight-loss surgery can greatly improve your health and emotional well-being. Obesity causes diabetes, heart disease, arthritis and sleep apnea. Weight-loss surgeries work either by restricting stomach size and/or the amount of calories your body can absorb. Though these surgeries can offer great benefits, their cost can put them out of reach to those without financial assistance. Luckily, if you're 65 or older, Medicare offers coverage for weight-loss surgery as long as you meet a short list of qualifications.
Physical and Medical Requirements
Medicare requires that you have a body mass index (BMI) of 35 or more. BMI is the measure of body fat in relation to your height and weight. You must also have at least one weight-related medical problem such as diabetes, heart disease or sleep apnea. You're required to undergo a psychological evaluation before approval. And you will need show through medical records that you've tried several other weight-loss methods before seeking surgery.
Other Requirements
For Medicare to cover any portion of your weight-loss surgery, it must be performed at an approved facility, or "Center of Excellence" for bariatric surgery, as Medicare calls them. To locate one of these facilities, visit the Centers for Medicare and Medicaid Services website (see Resources below). Along with the facility, the surgical option you choose must be Medicare-approved.
Amount of Coverage
The amount of coverage you receive depends on your Medicare plan. The original plan covers 80 percent of the approved amount, leaving the remaining 20 percent as your out-of-pocket expense. The MediGap supplemental plan coverage varies, but often leaves no out-of-pocket expense for the patient.
Types of Weight-Loss Surgery Covered by Medicare
There are three types of weight-loss surgery approved by Medicare. The first is Roux-en-Y bypass, the most commonly performed bariatric surgery in the United States. This procedure reduces the size of the stomach and diverts the small intestine, inhibiting the body's caloric absorption. This procedure can be performed using minimally invasive techniques or an open procedure.
Biliopancreatic diversion surgery (BPD) is another Medicare-approved procedure. It creates a small stomach pouch, removing a larger portion of the stomach than with the Roux-en-Y bypass. With this procedure, the digestive juices are diverted from the upper part of the small intestine, where most of our calories are absorbed, to the lower part. This procedure requires the removal of a larger portion of intestine than Roux-en-Y bypass surgery. Like the Roux-en-Y bypass, BPD can be performed using an open, or less-invasive, laparoscopic procedure.
Laparoscopic adjustable gastric banding is the third Medicare-accepted procedure. It uses an adjustable band to reduce the amount of food allowed into the stomach. Unlike bypass surgeries, no portion of the stomach or intestine is removed with this procedure.
Tags: Roux-en-Y bypass, This procedure, weight-loss surgery, bariatric surgery, diabetes heart, diabetes heart disease
