Will Medicaid Pay For Weight Loss Surgery?

Will Medicaid pay for weight loss surgery? Medicaid recipients with their weight reduction are covered by the program. Learn more about the Medicaid and Medicare programs that are available to you. Many chronic disorders, including diabetes, hypertension, cardiovascular disease, and cancer, can be associated with obesity. Medicaid funds various weight reduction programs and services as listed below since obesity is such a serious health concern.

In order to understand how Medicaid weight loss benefits are covered, it’s vital to understand how Medicaid coverage is divided down. In order to be eligible for Medicaid, you must meet a series of criteria. These are known as obligatory Medicaid benefits. Thereafter, states have more leeway when it comes to what additional benefits the state Medicare program can provide. Additional Medicaid benefits are known as optional Medicaid benefits. When offered as optional benefits, Medicaid coverage for weight reduction programs and services may differ from state to state.

Will Medicaid Pay For Weight Loss Surgery For Everyone?

A mandated benefit for Medicaid participants under the age of 21 is obesity screenings. Obesity screening is included in the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which is mandated by all Medicaid programs. In certain places, recipients beyond the age of 21 may also be eligible for this benefit, although it is not available in every state.

You can contact your state Medicaid program to find out what additional weight reduction benefits your state provides in addition to the national Medicaid benefits. A variety of weight-loss strategies, including education and counseling about a healthy diet and regular exercise, are covered by Medicaid programs in some states. As an optional benefit, these services may not include in every state’s Medicaid program.

Qualifications For Medicaid Weight Loss Surgery Coverage

In order to qualify for Medicaid coverage for weight reduction surgery, patients must meet all of the following conditions:

To be eligible, you must be a girl over 13 or a guy over 15. Overweight or obese, with at least one concomitant condition, such as diabetes or sleep apnea, you have a BMI above 35. You must have a BMI over 40 and at least one comorbidity if you are under the age of 21. The medical necessity for weight loss surgery document in writing by a doctor’s note. Psychological testing went well.

Your comorbidities document to have failed to respond to conventional therapy. Six months of medically supervised weight loss must complete and document, and the program must have taken place within a year following surgery. You know that your diet and lifestyle will have to alter following the procedure. Before and after the operation, you must have access to nutritional and psychological therapies.

Medicaid may not support weight reduction surgery if a patient has any of the following:

  • Chronic steroid use
  • Cancerous tumors
  • Irritable bowel syndrome
  • Pancreatitis that persists over time
  • Pregnancy
  • Recommendations for psychological treatment that might interfere with post-surgical lifestyle adjustments

These centers have reached a high degree of expertise in the field of bariatric surgery and must use for weight reduction surgery. The level of insurance coverage for bariatric surgery varies by state.

How Does Medicaid Cover Weight Loss Surgeries?

Beneficiaries with a BMI of 30 or above may be eligible for Medicare-covered obesity testing and behavioral counseling. Health insurance plans provide an initial BMI exam, up to two diabetes screenings a year, and nutritionist counseling to aid with diet and exercise.

A Diabetes Prevention Program is also available through Medicare for people who fulfill certain eligibility requirements. During the six-month program, participants will get training, suggestions, and methods for achieving and maintaining a healthy weight. This follows by a further six months of less intense follow-up training and an extra twelve months of continual maintenance training after the initial six months.

Patients with diabetes, renal disease, or a recent kidney transplant are eligible for medical nutrition therapy (MNT). MNT services include a nutritional and lifestyle evaluation, nutritional treatment, assistance in controlling lifestyle variables and healthy weight reduction, as well as follow-up visits to evaluate dietary habits. MNT services.

When Should You Apply For Medicaid Weight Loss Surgery Coverage?

Gastric sleeve, bypass, and lap band surgery are all cover by Medicaid in most circumstances. In some cases, Medicaid will cover these procedures since they deem medically necessary for the patient’s survival. In a gastric bypass, food transported directly to the lower intestine, bypassing the upper portion of your intestine. By reducing the stomach’s capacity, patients can eat fewer calories as a result of this treatment. If part of digestion skipped, the body will receive less calories and nutrients. As a result of this and the reduced caloric intake, you will lose weight.

In Lap-Band surgery, a band of silicon and balloons place around the upper portion of the stomach. As a result, there is less room for food storage and a narrower opening for food to enter the stomach as a result. The technique performed laparoscopically and is less invasive than previous procedures. The band may tighten or loosen, and the process can undo.

Sleeve-shaped gastric sleeve surgery is a method of reducing stomach size. So the food has less room to sit and moves down the intestines more quickly.  Many times, if they cover the operation, they’ll cover it entirely for the patient. If you don’t know what to expect, the process of acquiring insurance might be frustrating. To receive the insurance you need, be patient and follow a few simple procedures.

What Should You Do To Get Approval From Medicaid?

If Medicaid in your state covers bariatric surgery, the first step you should do is to consult with your doctor. In order for Medicaid to pay the procedure, there must be a medical need. In order to have the operation, you must be able to tell your doctor about your medical condition and the reason for it. The doctor might then send you to a qualified surgeon for further evaluation.

Discuss your options and go through the essentials of the operation with an approved surgeon during your first consultation. The Medicaid office might request a pre-approval of surgery after several tests have performed to determine your medical fitness for surgery. You’ll need to exercise some patience during this procedure since it might take some time. Before you can have surgery or begin the treatment, this is typically essential. This is to make sure you know exactly what to expect and what your involvement will be in your recovery and long-term well-being.

Do I Qualify for Weight Loss Surgery and Will My Insurance Cover it?


If you have a body mass index (BMI) of 40 or higher or a BMI of 35 to 39.9 with at least one obesity-related condition, such as high blood pressure, type-2 diabetes, and sleep apnea, you may have the qualifications for weight loss surgery. It is essential to discuss your individual health situation with your doctor and ask them, “do I qualify for weight loss surgery?” to determine if surgery is the best option for you. Your doctor can review your medical history, current medications, and dietary habits to decide whether weight loss surgery is right for you.

Furthermore, some insurance providers may cover part or all the procedure cost depending on your qualifying factors and plan. Therefore, asking, “does insurance cover weight loss surgery for me?” to your healthcare provider before making any decisions is best. Additionally, there are other important considerations regarding weight loss surgery, such as following a pre-operative diet plan and attending counseling sessions before and after the procedure. The next step would be to research different types of available procedures so that you can make an educated decision based on all the facts available. We hope this article gave you the incentive to research further the answer to “do I qualify for weight loss surgery?”