My Obesity Connection on HealthCentral gets a lot of questions from readers seeking free gastric bypass surgery. Free weight-loss surgery is virtually unheard of, but patients that are morbidly obese may qualify for the surgery under Medicare, while patients within a certain range of the federal poverty level and don't have insurance may qualify for the surgery under Medicaid. Surgery grants also may help those who cannot afford weight-loss surgery by funding all or part of the treatment costs.
Medicare is a federally-funded health insurance program that is available to people age 65 or older and for people under 65 with qualifying disabilities. Morbid obesity is one of the qualifying disabilities under the Social Security Act.
Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), which is part of the United States Department of Health and Human Services (HHS). To determine if you qualify for Medicare coverage, contact the local social services agency in your area or visit the CMS website or the HHS website for more information.
Medicaid is a federally-funded health insurance program that provides healthcare and related health-services to qualifying low-income people. Under Medicaid, obesity surgery is one of the Nationally-Covered Indications for patients who it is determined medically-necessary.
The Medicaid program is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). Medicaid eligibility is based on income and other factors such as age, disabilities, citizenship, and other resources.
Overview of coverage for gastric bypass surgery and gastric banding surgery
Medicare will cover weight-loss surgery for qualified patients when the procedure is performed by approved surgeons and facilities (see list of approved facilities at the end of this post).
Medicare qualified patients are Medicare beneficiaries who have a BMI (body mass index) greater than 35, have at least one co-morbidity related to obesity, have been unsuccessful in losing weight with previous medical treatments for obesity, and lap band surgery is considered a medical necessity. Approval for weight loss surgery is not automatic, but reviewed on a patient by patient basis.
From the Medicare National Coverage Determinations Manual:
Effective for services performed on and after February 21, 2006, Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.