Does Medicare cover weight loss treatments?
OKLAHOMA CITY (KFOR) – Does Medicare cover treatments and medication to help with weight loss?
The answer is yes, kind of.
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According Savvy Senior, around 30% of Americans age 65+ are dealing with obesity, but there are even more wanting to lose weight. Traditional Medicare helps with specific weight loss treatments like counseling and certain surgeries for overweight recipients. However, it does not cover programs or medications.
Who is eligible
For recipients to get available Medicare-covered treatments for weight loss, your body mass index (BMI), or your estimated body fat based on height and weight, needs to be 30 or higher.
A BMI of 30 or above is deemed obese and raises the risk for health problems, like some cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea. To determine your BMI, the National Institutes of Health has a free calculator.
What is covered
Officials say if your BMI is 30 or above, Medicare Part B will provide up to 12 months of weight loss counseling with a medical professional in a primary care setting, like a doctor’s office.
Most counselors will perform an initial obesity screening, a dietary assessment and look into behavioral therapy to help the patient focus on diet and exercise.
Medicare may also cover certain surgeries like bariatric and metabolic for those dealing with morbid obesity (BMI of 35 or above) and have at least one underlying health condition related to obesity, like heart disease or diabetes. The patient must also be able to show that they have tried to lose weight in the past through diet and exercise and have been unsuccessful.
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What is not covered
Original Medicare does not cover weight loss programs like fitness or gym memberships, or programs like Jenny Craig, Noom and WW (formerly known as Weight Watchers).
It also doesn’t cover weight loss drugs, but it does cover FDA approved diabetes drugs that have become popular for weight loss. Medicare Part D plans cover Ozempic and Mounjaro for diabetes only, so your doctor will need to prescribe these medications for diabetes in order for them to be covered.
Medicare also does not cover Wegovy or Zepbound because they’re approved for weight loss only.
Without insurance, weight loss medications can cost from $1,000 to $1,300 a month.
Medicare Advantage
If you’re enrolled in a private Medicare Advantage plan, you could have coverage for gym memberships and healthy food delivery programs. These are seen as expanded supplemental benefits and have been added over time to offer coverage for nutrition, health and wellness.
Reach out to your plan to see what is provided.
To learn more, visit SavvySenior.org.
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