Obesity is a significant health concern, especially among older adults, and its effects extend beyond mere physical appearance. It is linked to increased healthcare costs and numerous health conditions, such as heart disease, type 2 diabetes, stroke, some cancers, and sleep apnea. The good news is that obesity is treatable, and Medicare does offer coverage for certain weight loss treatments.
The Scope of the Problem
Obesity is not merely a cosmetic issue; it's a serious chronic condition. In 2013, the American Medical Association (AMA) officially recognized obesity as a disease. Ideally, a healthy Body Mass Index (BMI) should be between 18.5 and 24.9. A BMI of 30 or higher is considered obese and increases the risk for many health conditions. It is important to note that BMI isn't an entirely accurate measure of the weight you carry on your frame, as it doesn’t take into account how much fat you carry or where the fat is distributed, factors that can affect your metabolic health.
What Weight Loss Services Does Medicare Cover?
Medicare Part B has taken steps to recognize obesity as a major health problem and covers some obesity treatments, including:
Intensive Behavioral Therapy (IBT): Medicare covers appointments that take place in a primary care setting. Medicare covers counseling sessions for months seven through 12 if you’ve lost at least 6.6 pounds by your six-month appointment. This includes dietary assessments, as well as diet and exercise counseling. You would pay extra for any additional referred weight loss services, like consultations with a dietitian.
Bariatric Surgery: In cases of severe obesity (BMI of 35 or higher) and at least one underlying obesity-related health condition, such as diabetes or heart disease, Medicare covers bariatric surgery if it’s determined by your doctor to be medically necessary. To qualify for Medicare coverage of bariatric procedures, you must have a body mass index of 35 or higher and at least one other condition related to obesity, such as diabetes or heart disease. However, some bariatric procedures are specifically excluded by Medicare, such as open sleeve gastrectomy and gastric balloon. Medicare coverage of these procedures includes both malabsorptive and restrictive bariatric procedures, such as:
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- Roux-en-Y gastric bypass
- Biliopancreatic diversion with duodenal switch
- Adjustable gastric banding
- Sleeve gastrectomy
- Vertical gastric banding
Weight Loss Before Surgery: Part A may also fund a medically necessary pre-surgery weight loss program in an inpatient skilled nursing facility. If provided by a Medicare-approved facility, Part B will cover such a program elsewhere.
Nutritional Counseling: Part B will pay for a nutritionist for people living with diabetes, kidney disease, or those who have undergone a kidney transplant in the past 36 months. People on dialysis can also receive MNT as part of standard care.
Obesity screenings and counseling: If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling. Your doctor or primary care physician must perform these preventive services in a doctor’s office or primary care setting. They include:
- obesity screening
- dietary assessment
- nutrition counseling
What Weight Loss Services Are Not Covered?
Many common weight loss interventions are not fully covered by Medicare. Original Medicare may cover some weight management services, but it doesn’t generally cover weight loss programs, services, or medications. Unless preventive or medically necessary, most weight loss interventions aren’t covered by Medicare. That means you would pay out of pocket for services including:
- Services such as meal delivery for weight loss
- Programs such as Nutrisystem or Weight Watchers
- Anti-Obesity Medications (AOMs): Also known as pharmacotherapeutics, are also not covered by the Medicare Part D prescription drug benefit. This is despite the fact that these medications are increasingly recognized as an effective option for some people. Drug therapy is a key treatment component for certain groups of older adults living with obesity. It can be used to complement other treatment approaches covered by Medicare and enhance the person’s success. Drug utilized solely for weight loss are excluded from Medicare Part D coverage. This is a gap in the continuum of care. However, Medicare does cover weight-loss drugs when they're prescribed for other conditions approved by the FDA. For example, Medicare covers Ozempic, the semaglutide injectable drug used to treat type 2 diabetes, but it won't cover the drug when it's only prescribed for weight loss. GLP-1 medications (such as Ozempic) are glucagon-like peptide-1 agonists. In recent years, medications like Ozempic have become popular for helping people lose weight. Medicare Part D covers Ozempic and Mounjaro for diabetes only, not for weight loss. Do not start a weight-loss prescription without first consulting your primary-care physician to determine the benefits and potential risks. Without insurance these medications are expensive, often costing $1,000 to $1,300 per month.
Medicare Advantage (Part C) Plans
Medicare Advantage (Part C) is a private insurance plan that offers the same benefits as Original Medicare (parts A and B). This means that anything covered by Original Medicare should be covered by a Part C plan. Some Medicare Advantage (Part C) plans provide enhanced coverage that can support your weight loss efforts.
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In addition, some Part C plans may offer additional benefits not covered by Original Medicare, such as gym memberships, non-medically necessary weight loss programs, healthy meal delivery, or fitness programs like SilverSneakers. Some companies may charge extra for plans that include this type of coverage. A person can find the plans available in their area on Medicare.gov.
If you have Original Medicare, these programs are not covered by Medicare. You’ll pay the full price of these services out of pocket.
Before signing up for a Part C plan, a person should review the coverage it provides for these programs.
Costs Associated with Medicare Coverage
For services covered by Original Medicare, a person’s expenses will include premiums, deductibles, and coinsurance. In 2025, after reaching the annual Part B deductible of $257, Part B covers 80% of the cost of covered treatments or services. The Part B premium starts at $185, depending on a person’s income.
Most people do not pay a premium for Part A but do need to meet a deductible of $1,676. Once that is met, Part A can cover their hospital stay, surgical procedures, and any necessary inpatient services for up to 60 days. After 60 days, a person begins to face extra daily charges.
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Part C plans, meanwhile, are managed by private insurers and have different premiums, deductibles, and coinsurance depending on a person’s plan. To stay enrolled in a Part C plan, a person also still has to pay the Part B premium. That said, some Part C may cover this cost.
The Treat and Reduce Obesity Act (TROA)
Certain advocacy groups, such as the Obesity Action Coalition (OAC), are working on legislation to broaden access to treatment options for Medicare beneficiaries affected by obesity. For example, the Treat and Reduce Obesity Act (TROA) is a bipartisan bill designed to enable CMS to clarify that FDA-approved anti-obesity medications may be covered under Part D.
The Obesity Bill of Rights
Launched on Jan. 31, 2024, the Obesity Bill of Rights is endorsed by nearly 50 national obesity and chronic disease organizations. Learn about the Obesity Bill of Rights, a set of eight patient-centered principles established to ensure people with obesity are screened, diagnosed, counseled, and treated according to medical guidelines.
Other Weight Loss Strategies
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.
- Enjoy refined carbohydrates, such as sweets and soda, in moderation. These foods have low nutritional value and often replace more nutritious options.
- Drink water often and make it your primary drink throughout the day. Soda, alcohol, and other beverages are OK in moderation but can add extra calories.
- Find a diet that works for you in the long term, and avoid overly restrictive or dangerous fad diets. Always consult your doctor before making any major dietary changes.
- Weight loss programs can offer a great support system to help you meet your weight loss goals.