Obesity is a growing concern globally and has been described as a public health epidemic by the World Health Organization (WHO). It increases the risk of many health problems such as cardiovascular diseases, stroke, diabetes, and some types of cancer.

Sometimes, lifestyle modifications and traditional weight loss methods may not be enough to manage obesity, and surgery might be the only option left.

People with obesity are also concerned about the cost of surgery and if their insurance can help cover it. This article will explore the topic of whether health insurance covers obesity surgery.

What is Obesity Surgery?

Obesity surgery, also known as bariatric surgery, is a surgical procedure used to treat obesity by reducing the size of the stomach or restricting the amount of food intake.

The goal of this type of surgery is to achieve significant weight loss and improve health. Generally, surgery is considered as a last resort when other weight loss methods have failed.

There are different types of surgery available, and each has its advantages and disadvantages:.

Gastric bypass surgery: This is the most common type of surgery and involves creating a small pouch at the top of the stomach and attaching it to the small intestine.
Gastric sleeve surgery: This involves removing a portion of the stomach to reduce its size.
Gastric band surgery: This involves placing a band around the stomach to limit the amount of food that can be eaten.

Does Health Insurance Cover Obesity Surgery?

Health insurance coverage for obesity surgery varies depending on the insurance company and the type of surgery. Some health insurance plans cover the cost of obesity surgery, while others do not.

The coverage might also depend on whether the surgery is performed for medical reasons or for cosmetic reasons.

Most health insurance companies consider obesity surgery to be a medical necessity when other weight loss methods have failed, and there is a significant medical risk associated with obesity.

In such cases, insurance companies may cover the cost of surgery. However, some insurance companies require patients to undergo a period of medically supervised weight loss before approving surgery.

On the other hand, insurance companies might not cover the cost of obesity surgery if the surgery is considered cosmetic or if the individual does not meet the medical criteria for the surgery.

For example, if the individual has a body mass index (BMI) of less than 35, surgery might not be considered medically necessary.

It is essential to check with your insurance provider to determine if your policy covers obesity surgery. You can also consult with your doctor to help determine if surgery is the right choice for you and if it is medically necessary.

Does Medicaid Cover Obesity Surgery?

Medicaid is a government-sponsored health insurance program that provides coverage for low-income individuals and families. Usually, Medicaid covers obesity surgery when it is medically necessary and the individual meets certain criteria.

To qualify for obesity surgery through Medicaid, the individual must meet the following criteria:.

Have a BMI of 40 or higher or a BMI of 35 or higher with at least one obesity-related health condition.
Have tried other weight loss methods, such as diet, exercise, or medication, without success.
Be over 18 years of age.
Have no medical conditions that would put them at risk during surgery.

If the individual meets the criteria, Medicaid might cover the cost of surgery. However, the extent of coverage and requirements might vary depending on the state and the insurance plan.

Does Medicare Cover Obesity Surgery?

Medicare is a federal health insurance program that provides coverage for individuals who are 65 years of age or older, individuals with certain disabilities, and those with end-stage renal disease.

Medicare might cover obesity surgery if it is medically necessary and the individual meets the criteria.

To qualify for coverage, the individual must have a BMI of 35 or higher and at least one obesity-related health condition, such as high blood pressure or type 2 diabetes.

Before surgery, the individual must also undergo a six-month period of medically supervised weight loss to qualify for Medicare coverage. During this period, the individual must meet with their doctor regularly and follow a weight loss program.

If the individual meets the criteria and completes the six-month weight loss program, Medicare might cover the cost of surgery. However, the amount of coverage might vary depending on the type of surgery and the state.

Conclusion

Obesity surgery is an effective way to achieve significant weight loss and improve health. The cost of surgery can be a concern for many people, but it is reassuring to know that some insurance plans might cover the cost of surgery.

If you are considering obesity surgery, it is essential to check with your insurance provider to determine if your policy covers the surgery.

It would be best also to consult with your doctor to help determine if surgery is medically necessary and the right choice for you.