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Jul 4, 2024 · Efficacy: If used properly, WW is an effective diet tool. The plan can also help reshape a person’s relationship with dieting and exercise in general, potentially improving one’s lifestyle ...
- Overview
- Does Medicare offer coverage for weight loss programs?
- What weight loss services are covered by Medicare?
- What isn’t covered?
- How can I get the most coverage for weight loss management?
- The takeaway
•Original Medicare may cover some weight management services but doesn’t generally cover most weight loss programs, services, or medications.
•Some Medicare Advantage plans cover health and wellness services that relate to weight loss, such as fitness programs and gym memberships.
•In cases when it’s medically necessary, Medicare will cover weight loss surgery if you meet the eligibility requirements.
According to a 2013–2016 survey by the Centers for Disease Control and Prevention (CDC), almost half of U.S. adults attempted to lose weight within the past 12 months.
In addition to diet and lifestyle changes, weight loss programs are a popular option for people who want to lose excess weight. However, Medicare covers weight loss programs only when they’re deemed “medically necessary.”
In this article, we’ll explore when Medicare will cover weight loss programs, what services Medicare covers, and how to get the best Medicare coverage to help you maintain a healthy weight for you.
While Medicare offers a variety of preventive services to help you attain a healthy weight, it generally doesn’t cover weight loss services, programs, or medications. These include:
•services such as meal delivery for weight loss
•programs such as Nutrisystem or Weight Watchers
•FDA-approved diet pills or medications
However, there are some cases when original Medicare will provide preventive weight loss screenings and nutrition counseling — as long as you meet the eligibility criteria.
In addition, some Medicare Advantage (Part C) plans offer additional health and wellness services, like fitness programs and gym memberships.
Obesity screenings and counseling
If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling. These preventive services must be performed by your doctor or primary care physician in a doctor’s office or primary care setting. They include: •obesity screening •dietary assessment •nutrition counseling Obesity screenings and behavioral counseling are considered preventive services, which are covered under Medicare Part B. Part B is one part of original Medicare. Most of these services will cost you nothing out of pocket as long as you’ve met your Part B deductible for the year.
Nutritional counseling
Medical nutrition therapy (MNT) is often used to treat and manage certain health conditions, such as diabetes or kidney disease. This type of therapy includes: •nutrition and lifestyle assessment •nutritional therapy sessions •lifestyle management •follow-up visits Medicare will cover MNT if you have either of the conditions mentioned above or have had a kidney transplant within the last 36 months. Dialysis patients also receive MNT as part of standard care. MNT is considered preventive, so there’s no out-of-pocket cost for these services. However, your doctor will need to refer you to a registered dietitian for counseling.
Fitness programs
Original Medicare doesn’t cover gym memberships or fitness programs. However, some Medicare Advantage plans offer health and wellness benefits that cover these types of services. These may include: •SilverSneakers: one of the most popular fitness programs for adults age 65 and older •Renew Active: a program by UnitedHealthcare that covers gym memberships and other health and wellness programs and events •Silver&Fit: another fitness program that offers nationwide services both in person and online Before you enroll in a Medicare Advantage plan, check what kind of coverage it offers for these programs. Plans that include this type of coverage might have additional costs, depending on the company. Again, if you have original Medicare (parts A and B), you won’t be covered for any of programs. You’ll pay the full price of these services out of pocket.
Most weight loss interventions, unless preventive or medically necessary, aren’t covered by Medicare. Noncovered weight loss interventions may include:
•weight loss programs such as Weight Watchers or Nutrisystem
•weight loss procedures purely for aesthetic purposes, such as liposuction
•weight loss medications, including FDA-approved “diet pills”
Although Medicare does cover most bariatric surgery procedures, it doesn’t cover the following bariatric procedures:
•gastric balloon
Medicare enrollees who are interested in extra health and wellness coverage for weight loss should compare Medicare Advantage plans in their area.
Most Medicare Advantage plans offer additional coverage beyond what original Medicare covers — especially when it comes to perks such as fitness programs and gym memberships.
If you meet the coverage criteria listed above for weight loss surgery, you don’t need to enroll in a Medicare Advantage plan to be covered for these services. They’ll be covered under your original Medicare plan.
However, if you would like additional long-term support after surgery, Medicare Advantage plans may offer these health and wellness perks.
Even if your Medicare plan doesn’t cover the weight loss services you’re interested in, there are some dietary and lifestyle changes you can make on your own, including:
•Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, and healthy fats. Focus on lean protein and eat red and processed meats in moderation.
Weight loss programs can offer a great support system to help you meet your weight loss goals. However, original Medicare won’t cover most weight loss services unless they’re preventive or your doctor has decided that they’re medically necessary for your situation.
If you want Medicare coverage for these extra services, such as gym memberships and fitness programs, you’ll need to find a Medicare Advantage plan that meets your needs.
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