So, does Medicare cover weight loss programs? Well, the short answer is: yes. Yes, Medicare does typically cover certain weight loss drugs and aids, which include fad diet pills, as well as certain slimming patches, but those things are not typically covered as durable health equipment (DME) with Medicare. The types of drugs and treatments that Medicare covers under this section of coverage are listed on a list provided by the United States Department of Health and Human Services (HHS). According to the NHS, those types of drugs and treatments include "all non-cosmetic surgical methods approved by the FDA". These include: diet pills, stimulants (including ephedra), and diet aids such as sugars and syrups.
However, in order for a particular drug or treatment to be deemed eligible as a Medicare Part A drug or treatment, it must meet the standards of Part B. That's where the bulk of the confusion and debate arises. Medicare Part B covers the "outpatient" aspects of medicine - that is, hospital and home visits, doctor visits, etc. But it does not pay for exercise, dietary, or weight loss programs, in most cases. According to the Centers For Medicare & Medicaid Services (CMS), in order for a weight loss program to be considered "means sought", it has to "apply to one or more specific physical problems with a promise of cure."
According to CMS guidelines, the type of treatment the drugs or procedures cover depends on the state the procedure or drug is offered. That means there may be separate guidelines for different states. One guideline for states that do not offer Medigap plans says that any weight loss services "must not be billed under the name'medicare prescription drug plan'. And if the service is billed for a Medicare Part A policy, it is necessary to specify that it is not intended to provide a Medicare Part A policy benefit." That also means the medications or procedures cannot be administered to the patient while being used for weight loss purposes.
That doesn't mean you can't lose weight with me - you can! It just means you need to do your homework and find out exactly what's covered. In addition to being aware of the difference between Medigap and Medicare coverage, be aware that there are certain exclusions that may apply. One of the biggest is for "fitness enhancement" drugs. Any drug that is specifically meant to treat or improve an ailment will most likely be excluded from Medigap policies, even if it is necessary to take the medication during the weight loss program.
You will need to be careful about how you proceed once you realize that Medicare does not cover part of the expense involved in participating in weight-loss programs. If you lose a significant amount of excess weight, and Medicare no longer covers some of the expense, then there may be a gap in your Medicare coverage. In order to get coverage back, you will either have to come up with the money or pay the difference out of pocket. Obviously, this isn't a very pleasant option. The alternative is to seek out supplemental insurance to cover the difference.
If you qualify, there are various programs that will help you pay for the excess weight loss services you'll need. For example, Medicare Part B covers a range of healthcare costs related to eating. As a supplement to the insurance coverage, the government will pay a portion of the cost. If you decide to use this service, be aware that the government does not pay for the entire premium. You must pay the balance in full at the time of the policy renewal.
If you have Medicare Part A, you can also join the various weight loss programs offered by private companies. However, because it doesn't cover as much as Medicare Part B, the private companies won't cover as much of the premium. In order to get the full benefits of Part A, you will need to have Medicare Part B and also join the private companies' programs. Some people will decide to do both at the same time so that they receive the maximum benefit, even if their current health status makes it unlikely they'll need Medicare Advantage. Just make sure that you don't plan to drop any of these coverage once you get on Medicare.
Regardless of whether you're eligible for Medicare coverage, it's always a good idea to talk to a medical professional before making any decisions. Your physician can run tests and help you identify the best options for your own particular situation. It's often the case that Medicare coverage and weight loss programs are complimentary to each other, so there's really no reason to forego one while joining the other. If you're already on Medicare, you may want to check with your physician about the supplement's supplement eligibility requirements for you.
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