Medicare covers bariatric surgery, but only if you meet specific medical criteria and follow the steps your doctor and Medicare require.

Medicare Part B covers weight loss surgery when a doctor documents that you have a body mass index (BMI) of 35 or higher with obesity-related health problems, or a BMI of 40 or higher regardless of other conditions. The surgery must be performed at a Medicare-approved facility by a surgeon enrolled in Medicare. You will need to complete a supervised weight loss program before surgery — usually three to six months of visits with a doctor, dietitian, or both — and get written approval from Medicare before the procedure happens.

The amount Medicare pays depends on the type of surgery. Gastric bypass, gastric banding, and sleeve gastrectomy are the procedures most commonly covered. Your out-of-pocket cost is typically 20 percent of the approved amount after you have met your Part B deductible for the year. If you have a Medigap or Medicare Advantage plan, your costs may be lower.

Key Takeaways

  • Medicare covers bariatric surgery only when your BMI is 35 or higher with weight-related health problems, or 40 or higher without other conditions.
  • You must complete a supervised weight loss program with a doctor or dietitian for three to six months before Medicare will pay for surgery.
  • The surgery must take place at a Medicare-approved facility with a Medicare-enrolled surgeon, and you need written Medicare approval before the procedure.
  • You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible; Medigap or Medicare Advantage plans may reduce your share.

How Medicare Determines If You Meet the Medical Requirements

Medicare uses BMI and documented health conditions to decide whether to cover your surgery. Your doctor calculates your BMI from your height and weight. If your BMI is 35 or higher, Medicare requires that you also have at least one obesity-related condition — such as type 2 diabetes, high blood pressure, heart disease, sleep apnea, or joint problems — that your doctor expects surgery to improve. If your BMI is 40 or higher, you do not need another condition; the BMI alone qualifies you.

Your doctor must document these details in your medical record and submit them to Medicare as part of the approval process. Medicare's local contractor in your state reviews the documentation to confirm you meet the criteria. This review usually takes one to two weeks. If Medicare denies the request, your doctor can appeal with additional medical evidence.

The Supervised Weight Loss Program You Must Complete

Before Medicare will pay for bariatric surgery, you must participate in a supervised weight loss program. This is not a commercial diet program or an online app — it must be run by a doctor, registered dietitian, or both, and documented in your medical record. The program typically lasts three to six months and includes regular visits where a healthcare provider monitors your weight, eating habits, and readiness for surgery.

Some programs are offered through your doctor's office or a hospital. Others are run by weight loss clinics or bariatric surgery centers. Ask your doctor whether they run a program or can refer you to one that Medicare recognizes. You will need to bring proof of completion — usually a letter from the program stating the dates you attended and that you finished — when you submit your surgery request to Medicare.

Getting Medicare's Written Approval Before Surgery

After you complete the weight loss program, your surgeon submits a request to Medicare for prior authorization. This request includes your BMI, your health conditions, your weight loss program completion letter, and your surgeon's recommendation. Medicare's local contractor reviews it and sends a written decision, usually within one to two weeks.

Do not schedule your surgery until you have received written approval from Medicare. If you have surgery without prior authorization, Medicare may refuse to pay, and you could be responsible for the full cost. Your surgeon's office should handle the submission, but it is your responsibility to confirm that the request was sent and to follow up if you do not hear back within two weeks.

Which Bariatric Procedures Medicare Covers

Medicare covers four main types of weight loss surgery: gastric bypass, gastric banding, sleeve gastrectomy, and duodenal switch. Gastric bypass and sleeve gastrectomy are the most commonly performed and most often covered. Gastric banding is less common now but still covered. Duodenal switch is covered but performed less frequently.

Medicare does not cover some newer procedures, such as endoscopic sleeve gastroplasty or intragastric balloons, because there is not yet enough long-term evidence that they work. Your surgeon can tell you which procedures Medicare covers and which ones you would have to pay for out of pocket. If your surgeon recommends a procedure Medicare does not cover, you can choose to pay for it yourself, but Medicare will not contribute to the cost.

Your Out-of-Pocket Costs and How Insurance Plans Affect Them

Under Original Medicare (Part A and Part B), you pay 20 percent of the Medicare-approved amount for bariatric surgery after you meet your Part B deductible. The deductible for 2024 is $240, though this amount changes each year. The approved amount varies by location and facility, but bariatric surgery typically costs between $15,000 and $35,000 before insurance, so your 20 percent share could range from several hundred to several thousand dollars depending on the procedure and where you have it done.

If you have a Medigap plan, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your costs depend on that plan's rules — some cover bariatric surgery with a copay, others with coinsurance, and some may have higher out-of-pocket limits. Contact your plan before surgery to learn your exact costs.

What Happens If Medicare Denies Your Request

If Medicare denies your request for bariatric surgery, your surgeon can file an appeal. The appeal process has several levels: reconsideration (reviewed by a different Medicare contractor), followed by a hearing before an administrative law judge if you request one. Your surgeon's office usually handles the paperwork, but you may need to provide additional medical records or a letter from your doctor explaining why surgery is medically necessary for you.

Appeals can take several months. While your appeal is pending, you can continue with your weight loss program and work with your doctor on other ways to manage your health conditions. Some people are denied initially because their documentation was incomplete; resubmitting with more detail from your doctor often succeeds without a formal appeal.

Frequently Asked Questions

Do I have to use a hospital, or can I have surgery at an outpatient surgery center?

Medicare covers bariatric surgery at both hospitals and outpatient surgery centers, as long as the facility is Medicare-approved and the surgeon is enrolled in Medicare. Ask your surgeon where they perform the procedure and confirm that location is Medicare-approved before you schedule.

Does Medicare cover the follow-up visits and nutritional counseling after surgery?

Yes. Medicare covers office visits with your surgeon and visits with a registered dietitian after bariatric surgery. You pay your usual 20 percent coinsurance for each visit after you meet your deductible. Some Medicare Advantage plans may have different cost-sharing rules.

What if I lose weight on my own without the supervised program — can I skip that step?

No. Medicare requires the supervised program regardless of how much weight you have already lost. The program documents your commitment and readiness for surgery, and Medicare will not approve surgery without proof of completion.

Can I have bariatric surgery if I am on Medicare Advantage instead of Original Medicare?

Yes, but the coverage rules and your costs depend on your specific Medicare Advantage plan. Some plans cover bariatric surgery with the same requirements as Original Medicare; others have different rules or higher out-of-pocket limits. Contact your plan to learn what it covers before you start the weight loss program.

Will Medicare cover a second bariatric surgery if the first one does not work?

Medicare may cover revision surgery if your first surgery did not produce the expected weight loss or if you have a complication that requires a second procedure. Your surgeon must document the medical reason and submit a new prior authorization request. Coverage is not automatic, so discuss this possibility with your surgeon before your first surgery.