Does Medicaid Cover Weight Loss Surgery? – There are some people whose obesity problems cannot be resolved without weight loss surgery. It is well known that many people have tried and failed to lose weight by using other methods and programs.
The only way to achieve a healthy weight and lifestyle may be to undergo weight loss surgery. Many people cannot afford these surgeries because they are so costly. A bariatric surgery’s cost depends on the type of surgery, patient, and location.
A person’s weight can be affected by many factors, including lifestyle choices, illness, injury, or genetics, and obesity has often been associated with discomfort and poor health. Researchers have found that obesity greatly increases the risk of developing various illnesses, including cardiovascular disease and cancer.
The good news is that bariatric surgery provides a path to wellness and health for those unable to succeed with other medications. Some bariatric surgeries involve shrinking the stomach to reduce its capacity and changing the way digestive organs process food. There are several common and effective methods of bariatric surgery, including gastric bypass surgery, lap-band surgery, and gastric sleeve surgery.
What is Medicaid?
The Medicaid program is the federal government’s health care program for low-income families and individuals. Depending on the state, Medicaid generally covers weight loss surgery or not.
Does Medicaid Cover weight loss surgery?
Generally, Medicaid covers weight loss surgery if the patient meets eligibility criteria. It is up to your state to determine what coverage they offer, as each state has its policy. Medicaid guidelines do not explicitly mention bariatric surgery, but it is usually handled case-by-case. There are some criteria that need to be met for the patient to be covered for the surgeries. You must work with your physician to get Medicaid coverage for weight loss surgery.
Weight Loss Procedures Covered By Medicaid
Medicaid coverage of weight loss procedures has increased in recent years. The United States has a growing obesity epidemic. Many chronic diseases are linked to obesity, including heart disease, stroke, and diabetes.
Weight loss procedures covered by Medicaid include:
- Gastric bypass surgery
- Laparoscopic gastric banding
- Gastric sleeve surgery
It is important to discuss each of these procedures with your doctor to determine if it is right for you.
Here are a few reasons why weight loss is a good idea –
- The obesity rate among adults in the United States is estimated to be about one-third.
- The number is even higher for low-income adults.
- Studies have shown it can lead to significant weight loss and health improvements.
Make sure your state’s Medicaid office covers weight loss surgery if you’re thinking about it.
Criteria for Weight Loss Surgery Cost Coverage Through Medicaid
You will have to meet all of the following criteria for Medicaid to cover the full cost of your surgery and associated doctor visits.
- If you’re a female, you must be over 13; if you’re a male, you must be over 15.
- Body Mass Index (BMI) must exceed 35, along with at least one comorbid condition, such as high blood pressure, sleep apnea, and high cholesterol.
- Those under 21 must have a body mass index (BMI) greater than 40 with one or more comorbidities.
- If you are considering weight loss surgery, you must have a letter from your primary care physician recommending it.
- It is necessary to pass a mental health examination before making lifestyle changes for weight loss.
- You must provide documentation that you have tried to manage your weight and comorbidities using standard treatment but failed.
- A 6-month medically supervised weight loss program must be completed before surgery and must have been tried within the past 12 months.
You Might Not Qualify for Weight Loss Surgery Coverage
- Long-term steroids use
- Cancer of the malignant type
- Pregnancy, inflammatory bowel disease, or chronic pancreatitis
- The non-compliance with medical treatment
- Your new diet and lifestyle could be interfered with by psychological treatment.
Which Other Medicaid Considerations Are Required?
Other than the requirements shared above, there are some potential considerations you should be aware of depending on your state. Pregnant women, people with disabilities, or people who are blind are considered when applying for Medicaid. Medicaid eligibility also requires meeting assets and income limits.
You should also keep in mind a few Medicaid considerations. You should know these factors and how they might impact your Medicaid eligibility.
Asset transfers
An asset transfer occurs when one person transfers assets to another. Medicaid often requires individuals to do this to qualify since it reduces the overall value of their assets. It can be done through gifting or trust.
Spousal impoverishment
“spousal impoverishment” refers to a situation where a Medicaid recipient’s spouse may struggle to cover basic needs due to insufficient income and resources.
Procedures for Weight Loss that Medicare will pay
Medicaid covers a few weight loss procedures.
The procedures are as follows:
Bariatric Surgery
People with obesity can lose weight and maintain their weight loss through bariatric surgery. To determine whether bariatric surgery is right for you, you should work with a team of healthcare professionals. You may also have a dietitian, a psychologist, a psychiatrist on your team, and a physical activity specialist.
Please Note – Bariatric surgery is not a quick fix. However, bariatric surgery might be for you if you have tried other weight loss methods without success and have struggled to lose weight.
Gastric Bypass Surgery
Gastric bypass surgery is an effective weight loss method other than diet and exercise. During surgery, a small pouch is created at the top of the stomach and connected directly to the small intestine. In this way, food and calories are absorbed less from the stomach and intestines, reducing the amount of calories and food consumed.
A gastric bypass surgery is a serious operation only recommended after all other weight-loss options have failed.
Please Note – Complications, such as infection, bleeding, and blood clots, are risks following the surgery. It is also possible for the stomach pouch to leak. The risks and benefits of the surgery should be discussed with your doctor before deciding whether to proceed.
Sleeve Gastrectomy
The sleeve gastrectomy (SG) involves removing a significant portion of the stomach to reduce food intake and create a feeling of fullness. The surgery is considered a type of bariatric surgery that helps people lose weight when they are obese.
This type of bariatric surgery is a recent development, and it’s often used to treat obesity as a first-line treatment. Compared to other types of bariatric surgery, such as gastric bypass, SG is less invasive and has a lower risk of complications. Furthermore, it takes less time to recover than other types of bariatric surgery.
Please Note – It is important to note that Sleeve Gastrectomy is a serious surgery unsuitable for everyone.
Laparoscopic Adjustable Gastric Banding
The Laparoscopic Adjustable Gastric Banding procedure involves placing an inflatable band around the upper part of your stomach. In LAGB, small incisions and special instruments are used for minimally invasive surgery.
The procedure can be performed as an outpatient procedure so that it can be completed on the same day as the procedure.
Please Note – It is important to note that LAGB is generally safe and effective. There is a risk of infection, bleeding, and stomach or intestinal damage.
Medicaid will also cover certain costs associated with these procedures, such as anesthesia, hospitalization, and post-operative care. Patients need to discuss the risks and benefits of these procedures with their doctor before undergoing them.
FAQs
What amount does Medicaid cover?
When Medicaid is approved, bariatric surgery is usually covered in full. If Medicaid does not cover any part of your health care, you might be able to get gap insurance or supplemental insurance. After Medicaid coverage has been approved, it can be done. Additional insurance coverage can be added to gap coverage.
Who is eligible for Medicaid coverage for weight loss surgery?
The patient must be at least 30 kg overweight with a serious weight-related health condition, such as type 2 diabetes, hypertension, or sleep apnea.
How much does Medicaid pay?
The Medicaid reimbursement rates vary from provider to provider, as they are based on their fee schedules. There is, however, a general difference between Medicaid reimbursement rates and those of commercial insurance. Several factors will determine how much Medicaid will cover, including the type of service and the location.
