Savvy Senior: Does Medicare cover weight-loss treatments?

Dear Savvy Senior,

Does Medicare cover any weight-loss treatments for overweight retirees? I just turned 65 and need to lose about 100 pounds and would like to know if Medicare can help.

— Overweight Owen      

Dear Owen,

Yes, traditional Medicare does indeed cover some weight-loss treatments like counseling and certain types of surgery for overweight beneficiaries, but unfortunately it doesn’t cover weight-loss programs or medications. Here’s what you should know.

WHO’S ELIGIBLE

For beneficiaries to receive available Medicare-covered weight-loss treatments your body mass index (BMI), which is an estimate of your body fat based on your height and weight, must be 30 or higher.

A BMI of 30 or above is considered obese and increases your risk for many health conditions, such as some cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea. To find out your BMI, the National Institutes of Health has a free calculator that you can access online at nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.

WHAT’S COVERED

If you find that your BMI is 30 or higher, Medicare Part B will cover up to 12 months of weight-loss counseling conducted by a medical professional in a primary care setting (like a doctor’s office).

Most counseling sessions entail an initial obesity screening, a dietary assessment and behavioral therapy designed to help you lose weight by focusing on diet and exercise.

Medicare also covers certain types of bariatric and metabolic surgery for morbidly obese beneficiaries who have a BMI of 35 or above and have at least one underlying obesity-related health condition, such as diabetes or heart disease. You must also show that you’ve tried to lose weight in the past through dieting or exercise and have been unsuccessful.

These procedures make changes to your digestive system to help you lose weight and improve the health of your metabolism.

Some common bariatric surgical procedures covered include Roux-en-Y gastric bypass surgery, which reduces the stomach to a small pouch that makes you feel full even following small meals. And laparoscopic adjustable gastric banding, which inserts an inflatable band that creates a gastric pouch encircling the top of the stomach.

WHAT’S NOT COVERED

Unfortunately, original Medicare does not cover weight-loss programs such as fitness or gym memberships, meal delivery services, or popular weight-loss programs such as Jenny Craig, Noom and WW (formerly Weight Watchers).

Medicare also does not cover any weight-loss drugs, but it does cover FDA approved diabetes drugs that have unintentionally become very popular for weight loss.

Medicare Part D plans cover Ozempic and Mounjaro for diabetes only, not for weight loss! So, your doctor will need to prescribe these medications for diabetes in order to get them covered.

Medicare also does not cover Wegovy or Zepbound because they’re approved only for weight loss.

The reason behind the weight-loss drug omission is the Medicare Modernization Act, which specifically excluded them back when the law was written 20 years ago. They also excluded drugs used for cosmetic purposes, fertility, hair growth and erectile dysfunction.

Without insurance, weight-loss medications are expensive, often costing $1,000 to $1,300 a month. To help curb costs, try websites like GoodRX.com or SingleCare.com to find the best retail prices in your area. Or, if your income is limited, try patient assistance programs through Eli Lilly (LillyCares.com) which makes Mounjaro and Zepbound, or Novo Nordisk (NovoCare.com) the maker of Ozempic and Wegovy.

MEDICARE ADVANTAGE

If you happen to be enrolled in a private Medicare Advantage plan, you may have coverage for gym memberships and some weight loss and healthy food delivery programs. These are considered expanded supplemental benefits and have gradually been added to some plans to provide coverage for nutrition, health and wellness. Contact your plan to see what it provides.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.