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.
Effective for services performed on and after February 12, 2009, the Centers for Medicare & Medicaid Services (CMS) determine that Type 2 diabetes mellitus is a comorbidity for purposes of this NCD.
These procedures are only covered when performed at facilities that are:
- Certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center; or
- Certified by the American Society for Bariatric Surgery (ASBS) as a Bariatric Surgery Center of Excellence
Like many insurance programs, Medicare patients may have a co-payment amount even if they qualify. Although Medicare pays for weight-loss surgery, they do not pre-authorize so it is important to be certain of the requirements for surgery coverage.
Facilities Approved for Bariatric Surgery: A list of facilities that have met the CMS' minimum facility standards for bariatric surgery and have been certified by ACS and/or ASBS. At this writing there are more than 500 approved facilities. Click Here
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You can read about my decision to have weight loss surgery back in 2003 and my journey to maintain a lifetime of obesity disease management since that time. My wish is to help you on your own journey of lifetime obesity disease management with shareposts along the way to help you navigate that journey successfully.
Published On: August 01, 2011