Does Medicare Cover Nutritional Counseling for Obesity?
Medicare typically doesn’t offer weight loss benefits. However, Medicare may cover certain surgical procedures for morbid obesity when your body mass index, AKA BMI, is equal to or greater than 35 and you have one or more co-morbidities such as type 2 diabetes.
These Medicare-covered weight loss services may include:
- Lap-band surgery
- Gastric bypass surgery
- Other bariatric surgical procedures.
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Weight Management and Morbid Obesity
The World Health Organization (WHO) defines overweight or obesity as “abnormal or excessive fat accumulation” with health risk implications. Obesity can contribute to the development of long-term serious medical conditions.
If you’ve been diagnosed with obesity, your physician has likely recommended weight loss. Unfortunately, weight management is not that simple. If you’re dealing with chronic illness, take regular medications, or have mobility restrictions, it may be more difficult to lose weight.
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What is a Healthy Weight for Older Adults?
Although you may hear people use overweight and obese as interchangeable terms, the medical community uses a measurement of mass and height to make a distinction for screening and counseling purposes. The measurement, called a body mass index (BMI), is a calculation that factors in mass and height.
The standard protocol for adult weight ranges places you in a healthy range if your BMI is 18.5 to 24.9. What’s the difference between being overweight and obese? According to the National Heart, Lung and Blood Institute, overweight is the status for a BMI of 25 to 29.9. While obesity is defined as a BMI over 30.
- BMI 18.5 or lower = Underweight
- BMI 18.5-24.9 = Normal weight
- BMI 25-29.9 = Overweight
- BMI 30-34.9 = Class I obesity
- BMI 35-39.9 = Class II obesity
- BMI over 40 = Class III obesity
The subject of weight loss is controversial, particularly in the case of older adults. The adult BMI guidelines are not broken down by age.
When evaluating an optimal BMI for older adults, it’s important to take into account other factors, such as hypertension, insulin resistance, sleep apnea and other comorbidities, along with your health history, muscle mass and nutritional status. It’s best to talk to your doctor about the potential benefits and detriments of weight loss with respect to your age and health conditions.
Does Medicare Cover Morbid Obesity Treatment?
The National Health and Nutrition Examination Survey (NHANES) report released in 2021 revealed that 73.6% of adults are overweight, and that includes people who are obese. The statistic for obesity alone is 41.9% of the U.S. adult population. A wide range of medical interventions may be available to help you lose weight, and your Medicare coverage may cover some treatment. This may include counseling from a licensed nutritionist.
Medicare Part B (medical insurance) provides coverage for medically necessary outpatient services, doctor visits, and durable medical equipment. Benefits also include some preventive services. Medicare may cover obesity support if you meet specific criteria.
If you have Original Medicare, you will need to use providers that accept assignment. Providers who accept assignment invoice Medicare directly for their services without charging you back for any amounts above what Medicare approves. If applicable, you pay only the deductible and coinsurance.
As an alternative to Original Medicare, you may enroll in a Medicare Advantage (MA) plan. MA plans are offered by private insurance companies but are required to provide the same Part A and Part B benefits as Original Medicare. Many MA plans include a range of additional benefits such as fitness programs or nutritional counseling.
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Obesity Behavioral Therapy and Medicare
Medicare obesity counseling entails a BMI screening, dietary evaluation and counseling. This benefit is based on the premise that you can succeed in losing weight by learning behaviors that help you commit to a healthy diet and exercise program.
The Medicare BMI requirement for eligibility for Medicare obesity counseling is 30 or more. Medicare also stipulates that weight management and nutrition counseling takes place in a primary care facility to ensure that you have a personalized plan coordinated with the other healthcare services you are getting.
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How Does Medicare Cover Nutritional Counseling?
Proper nutrition is important as you approach weight loss. Figuring out how to balance your diet, lower calorie intake, and improve your health can be challenging. It can help to work with a nutritionist to create a plan as you start or continue your weight loss journey.
Medicare may cover nutritional counseling for obesity under certain circumstances. For instance, you’ll need to get counseling in a primary care setting (like a doctor’s office) where your nutrition plan can be coordinated with other care you may need. Talk to your doctor about your nutrition concerns and discuss the options available.
If you have diabetes or have undergone a kidney transplant within the past three years, you may be eligible for the Medicare medical nutrition therapy benefit. Your doctor’s referral is a prerequisite, and the provider delivering the service must satisfy specific requirements. For some people, nutritional counseling is key to adopting lifestyle changes that help you control diabetes and kidney disease.
Your nutrition counseling benefit will likely start with an assessment of your current nutrition patterns and lifestyle.
Your counselor may recommend individual sessions, group therapy, or both. Scheduling follow-up touchpoints can keep you on track. With the support of a Registered Dietitian or another qualified nutrition practitioner, you can learn to manage lifestyle variables that distract you from your goals.
Is Lap Band Surgery Covered by Medicare?
Laparoscopic banding surgery, commonly known as lap band surgery, is covered under the bariatric surgery benefit if you have specific morbid obesity-related health issues. Medicare coverage for morbid obesity, a term being replaced by class III obesity, generally applies to a BMI of 40 or more. However, people with obesity-related health issues such as diabetes or high blood pressure may be identified as having morbid obesity even with a BMI of 35.
Medicare covers medically necessary surgery under Part A or Part B depending on where your procedure is performed. Your surgical benefits vary depending on the type of facility where the surgery is performed. Part A covers inpatient care, and Part B covers outpatient care.
Physician services for pre-operative or post-operative care are generally covered under Part B whether you are an inpatient or outpatient.
Maintaining Healthy Weight
Weight is a topic of conversation that continues around body image, nutrition and access to healthy food. Talk to your doctor to discuss any concerns you may have regarding your weight, and if medically necessary, consider obesity screening and weight loss treatment available through Medicare.
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