Is Medicare Eligibility for Gastric Bypass Medically Necessary?

Is Medicare Eligibility for Gastric Bypass Medically Necessary?

May 6, 2021

If you are considering gastric bypass medicare to lose weight, Medicare might be the deciding factor. For many people with obesity, gastric bypass surgery is medically necessary to help them shed unwanted pounds and gain a healthy backside. Although Medicare covers bariatric surgery when it is medically necessary, not all patients qualify for the coverage. Bariatric professionals at both the Center for Medicare Services (CMS) and The Medicare Advantage Program (MAP) can help patients understand their eligibility for weight loss surgery and the benefits that they will receive.


In order to determine if gastric bypass Medicare is an appropriate treatment option, a patient should discuss his or her medical history and current health condition with a board certified Gastric Bypass specialist. Medicare coverage is not based on medical necessity, so if you have had surgery before, you will not qualify. Many specialists believe that obesity is the most preventable cause of death and recommend that obese individuals lose 30 percent of their excess weight through diet and exercise. For those who are medically eligible for the surgery, the costs can be very expensive, which is why most individuals with obesity are not able to afford the extensive healthcare that is available through their Medicare prescription benefit.


If you are obese and have exhausted your prescription benefit, then gastric bypass surgery is medically necessary. If you do not meet the criteria for Medicare part b and your weight loss surgery will not be covered by your state’s Medicaid program, the lap band is the only alternative. Lap band surgery is not covered by Medicare part b, so you will have to pay for the entire cost of the procedure out of pocket. In addition, you must pay for the surgical services and rehabilitation yourself. In many cases, gastric bypass surgery is covered as an elective procedure, but you may need to obtain approval from your physician to perform the procedure.

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