Does Medicare Cover Nutritional Counseling for Obesity?

Health Compare
Nov 23, 2022

Medicare typically doesn’t offer weight loss benefits. However, Original Medicare may cover certain surgical procedures for morbid obesity when your body mass index, AKA BMI, is equal to or greater than 35 and you have one or more co-morbidities such as type 2 diabetes.

These Original Medicare-covered weight loss services may include:

• Lap-band surgery
• Gastric bypass surgery
• Other bariatric surgical procedures.

Weight Management and Morbid Obesity

The World Health Organization (WHO) defines overweight or obesity as “abnormal or excessive fat accumulation” with health risk implications. Obesity can contribute to the development of long-term serious medical conditions.

If you’ve been diagnosed with obesity, your physician has likely recommended weight loss. Unfortunately, weight management is not that simple. If you’re dealing with chronic illness, take regular medications, or have mobility restrictions, it may be more difficult to lose weight.

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What is a Healthy Weight for Older Adults?

Although you may hear people use overweight and obese as interchangeable terms, the medical community uses a measurement of mass and height to make a distinction for screening and counseling purposes. The measurement, called a body mass index (BMI), is a calculation that factors in mass and height.

The standard protocol for adult weight ranges places you in a healthy range if your BMI is 18.5 to 24.9. What’s the difference between being overweight and obese? According to the National Heart, Lung and Blood Institute, overweight is the status for a BMI of 25 to 29.9. While obesity is defined as a BMI over 30.

• BMI 18.5 or lower = Underweight
• BMI 18.5-24.9 = Normal weight
• BMI 25-29.9 = Overweight
• BMI 30-34.9 = Class I obesity
• BMI 35-39.9 = Class II obesity
• BMI over 40 = Class III obesity

The subject of weight loss is controversial, particularly in the case of older adults. The adult BMI guidelines are not broken down by age.

When evaluating an optimal BMI for older adults, it’s important to take into account other factors, such as hypertension, insulin resistance, sleep apnea and other comorbidities, along with your health history, muscle mass and nutritional status. It’s best to talk to your doctor about the potential benefits and detriments of weight loss with respect to your age and health conditions.

Does Medicare Cover Morbid Obesity Treatment?

A wide range of medical interventions may be available to help you lose weight, and your Original Medicare coverage may cover some treatment. This may include counseling from a licensed nutritionist.

Medicare Part B (medical insurance) provides coverage for medically necessary outpatient services, doctor visits, and durable medical equipment. Benefits also include some preventive services. Original Medicare may cover obesity support if you meet specific criteria.

If you have Original Medicare, you will need to use providers that accept assignment. Providers who accept assignment invoice Medicare directly for their services without charging you back for any amounts above what Medicare approves. If applicable, you pay only the deductible and coinsurance.

As an alternative to Original Medicare, you may enroll in a Medicare Advantage (MA) plan. MA plans are offered by private insurance companies but are required to provide the same Part A and Part B benefits as Original Medicare. Many MA plans include a range of additional benefits such as fitness programs or nutritional counseling.

TIP: Use the Plan Finder Tool to find more of the nutritional benefits you need.

Obesity Behavioral Therapy and Medicare

Original Medicare obesity counseling entails a BMI screening, dietary evaluation and
counseling. This benefit is based on the premise that you can succeed in losing weight by
learning behaviors that help you commit to a healthy diet and exercise program.

The Original Medicare BMI requirement for eligibility for obesity counseling is 30 or more.
Original Medicare also stipulates that weight management and nutrition counseling take place
in a primary care facility to ensure that you have a personalized plan coordinated with the other
healthcare services you are getting.

How Does Medicare Cover Nutritional Counseling?

Original Medicare may cover nutritional counseling for obesity under certain circumstances.
For instance, you’ll need to get counseling in a primary care setting (like a doctor’s office) where
your nutrition plan can be coordinated with other care you may need.

If you have diabetes or have undergone a kidney transplant within the past three years, you
may be eligible for the Original Medicare medical nutrition therapy benefit.

Is Lap Band Surgery Covered by Medicare?

Laparoscopic banding surgery, commonly known as lap band surgery, is covered under the
Original Medicare bariatric surgery benefit if you have specific morbid obesity-related health
issues. Original Medicare coverage for morbid obesity generally applies to a BMI of 40 or
more, but people with obesity-related health issues such as diabetes or high blood pressure
may qualify with a BMI of 35.

Original Medicare covers medically necessary surgery under Part A or Part B depending on
where your procedure is performed.

Maintaining Healthy Weight

Talk to your doctor to discuss any concerns you may have regarding your weight, and if medically necessary, consider obesity screening and weight loss treatment available through Original Medicare.

TIP: Use the Medicare plan finder to find plans that include nutrition benefits and compare them against your existing coverage.