Medicare for Weight Loss Surgery

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Medicare programs provide health-care coverage for people who are 65 years and older, those under 65 with specific disabilities, and people of any age with permanent kidney failure requiring dialysis or a kidney transplant. It also covers some bariatric surgical procedures, such as gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity, it, however, does not exempt you from all out-of-pocket costs associated with Medicare coverage.

There are four parts to Medicare coverage, which include;

Part A and B were known as the Original Medicare and provide benefits and coverage for Inpatient hospital care; inpatients stays in most skilled nursing facilities as well as hospice and home health services. Part B benefits include doctor and clinical lab services, outpatient and preventive care, home health care, screenings, surgical fees and supplies, physical and occupational therapy

Medicare Part C known as the Medicare Advantage combines hospital insurance part A and medical insurance part B. All Medicare Advantage plans have an annual limit on your out-of-pocket costs for Medicare-covered amenities

Medicare Part D known as Prescription Drug Plan covers the cost of prescription drugs.

When planning for financing bariatric surgery, it is important to carefully review the details of each plan and make an informed assessment of your overall circumstance, including your current health, budget, and leniency for financial risk. Medicare Advantage plans are similar to private insurance that are run by private insurance companies but regulated by the government. They have different monthly premiums, copays, coinsurance and out-of-pocket limits and offer coverage that is similar to original Medicare parts A and B as discussed above. Therefore, you may want to get Medicare Advantage instead of original Medicare simply because this type of plan will cover bariatric surgery, services, and prescription drug coverage. Additionally, Medicare Advantage plans, by law, have an out-of-pocket maximum of about $6,000, which means that once you reach that limit, the plan can pay for all your covered expenses.

One thing to keep in mind is that Medicare Advantage plans, like other private health plans, naturally charge additional monthly premiums of about $30 – $65. Another drawback is that unlike original Medicare plane, Medicare Advantage plans are designated HMOs. Therefore, you may need prior authorization from a primary care doctor to see a specialist,

Because it is difficult to know the exact surgery costs in advance, it is important to ask your surgeon or facility how much you will have to pay for the surgery and any care afterward. Medicare also covers obesity behavioral screening and counseling sessions – officially known as Intensive Behavioral Therapy for Obesity – to help you lose weight, which allows your primary care doctor, a nurse practitioner, clinical nurse specialist or physician assistant to discuss weight issues with patients, advise them on diet and exercise, monitor progress and provide encouragement in regular visits. You are not required to pay any co-pays or deductibles if you are enrolled in Original Medicare.

Provided that your body mass is 30 or higher, these obesity counseling coverage include:

  • One session each week for the first month
  • One session each week for 2 to 6 months
  • Monthly sessions for another six months depending on the weight that you have lost

Obesity (among other diseases such as smoking) is one of the leading causes of preventable death all over the world and experts have welcomed the Intensive Behavioral Therapy for Obesity coverage by Medicare owing to the fact that these sessions can be administered outside of the framework of any associated chronic conditions, such as diabetes, allowing doctors to tackle the problem from its origin rather than the weight on its own.

Providing nutrition and weight-control advice to overweight patients may help promote significant behavior change through demonstrating to them how the extra weight may put them at risk for developing type 2 diabetes, heart disease, kidney disease, stroke, and certain cancers in the future. Patient counseling may also give a patient’s primary care doctor the chance to pinpoint and address other health concerns such as depression, low self-esteem, drug, and alcohol use that may be affecting their physical or emotional health.

Medicare’s new approach is an essential step in the right direction not only in treating obesity in the older generation, but also minimizing the chances of young adults becoming obese in the future. It also benefits bariatric patients because unlike before when doctors lack the essential training in nutrition and exercise therapy to provide comprehensive treatment services for their patients, the new Intensive Behavioral Therapy for Obesity coverage by Medicare ensures that patients are served by a specialist in an area pertinent to their obesity needs, such as a registered dietitian, exercise therapist or an obesity medicine specialist.

Make sense of health insurance options or reviewing insurance benefits can be daunting for many people. It would appear more natural to watch paint dry than choose an insurance plan. However, with some diligence, preparation and knowing where to look for relevant insurance information, this process can be a breeze. Choosing a health care plan is a very personal and individual choice that people should take the time to think about regarding gauging how often they will use the insurance and what kind of care they might need.

Understanding your insurances’ premiums, deductibles, copays, network as well as understanding other benefits that are included in your insurance plan may help you navigate the vast seas of coverage. Whether you are talking about Original Medicare, Part A, and Part B, or private insurance, Medicare Cost plans may or may not available in your area, which requires research or contacting a licensed insurance agent, who regardless of whether you purchase it from them, individual plans carry the same costs and offers the same benefits.

Do not put off the decision until the last minute. You can complete the online application through the Social Security Administration website and receive a decision letter in the mail.


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