What to Know About Medicare and Weight Loss Programs

• Original Medicare does not cover most weight loss programs. However, Original Medicare may provide coverage for preventive services. For example, Medicare covers obesity screenings, behavioral counseling, and other health services if a Medicare beneficiary meets the eligibility requirements.

• Many Medicare Advantage plans or Medigap plans may help cover the costs of weight loss programs. Some plans may also include weight loss counseling as one of its added benefits.

Losing weight can be a difficult process, both emotionally and physically. Because of this, having solid support is vital for losing excess weight successfully. For many people, this may mean joining a weight loss program. But does Medicare cover weight loss programs? 

In short, Medicare will not cover most weight loss programs. That said, Medicare covers preventative services, such as obesity screenings, to help someone maintain a healthy weight. Learn more about weight loss programs, weight management, and Medicare below.

A conventional weight loss program is one that combines nutritional counseling, exercise, and behavioral therapy to address weight loss. It can be difficult to lose excess weight, especially as we age, which is why the goal of most weight loss programs is to provide support to individuals on their weight loss journey.

In most cases, Medicare doesn’t cover weight loss programs, weight loss services, or weight loss medications. This includes: 

• Meal delivery services

• Programs (WW, Noom, etc.)

• FDA-approved diet pills or medications

• Gym memberships and other fitness programs

That said, Original Medicare covers preventative services for weight loss, such as behavioral counseling, so long as a beneficiary meets certain criteria.

Original Medicare may provide coverage for obesity behavioral therapy, medical nutrition therapy, and some bariatric surgery procedures. However, eligibility requirements will vary for each service.

Obesity Behavioral Therapy

Obesity behavioral therapy consists of an obesity screening, a dietary assessment, and nutrition counseling as a means of helping someone lose weight. These preventive services focus primarily on diet and exercise.

Eligibility requirements include: 
 

• A body mass index (BMI) of 30 or higher
• The counseling must be performed in a primary care setting

If all of the aforementioned is true, Medicare Part B covers obesity behavioral therapy. Total costs are usually $0 so long as the yearly Medicare Part B deductible has been met. As well, the primary care physician (PCP) or other health care professional must accept the Medicare assignment in order for it to be covered.

Note: Learn more about obesity behavioral therapy and Medicare coverage at this resource.

Medical Nutrition Therapy (MNT)

Medical nutrition therapy (MNT) consists of the following:
 

• Initial nutrition and lifestyle assessment
• Individual and/​or group nutritional therapy services
• Assistance with lifestyle factors that affect diabetes
• Follow-up visits to check diet management progress

Medicare Part B may cover MNT and related services so long as eligibility requirements are met. Eligibility requirements include: 
 

• Diabetes
• Kidney disease
• A kidney transplant within the last 36 months

If all of the aforementioned is true, Medicare Part B covers MNT. Since MNT is considered a preventive service, there is no co-payment for this service. As well, the Medicare Part B deductible does not apply.

Note: Learn more about medical nutrition therapy services and Medicare coverage at this resource.

Surgeries and medications may be prescribed for adults who are trying to lose weight but haven’t seen results from nutrition and lifestyle changes alone. These services can be expensive and while Medicare does sometimes pay for these, coverage often depends on the purpose for the treatment and risk level of an individual. 

Weight Loss Surgery

Many bariatric surgical procedures are covered by Medicare, so long as they are deemed medically necessary. Some bariatric surgical procedures that are covered include gastric bypass surgery and laparoscopic banding surgery.

Medicare beneficiaries must meet certain conditions that are related to morbid obesity to be covered. Such criteria include: 

• A BMI of 35 or above
• At least one co-morbidity related to obesity
• Previously unsuccessful with medical treatment for obesity

Weight loss procedures for aesthetic reasons are not covered.

Note: Learn more about bariatric surgery and Medicare coverage at this resource.

Weight loss drugs

FDA approved medications like semaglutide and tirzepatide can promote weight management in individuals over a certain body mass index or with certain comorbid conditions like heart disease, stroke, and type 2 diabetes. When prescribed by a doctor’s office for a related condition, Medicare mya cover these drugs. They don’t cover them when prescribed exclusively for weight management.

Before starting any of these medications, confirm with your Medicare Part D provider if these are covered.

A Medicare Advantage plan, also known as an MA plan or Medicare Part C, has the same covered services as Original Medicare since Medicare Part C bundles both Medicare Part A and Medicare Part B. That said, a Medicare Advantage plan typically has additional benefits and coverage. This may include fitness programs, weight management services, prescription drug coverage, and other wellness programs. Medicare beneficiaries should contact their insurance company to learn more.

Medicare supplement plans, also known as Medigap or MedSupp, are policies that ​“fill in the gaps” of Original Medicare, providing a more comprehensive health care plan. Like MA plans, Medigap plans may help cover the costs for weight management services and fitness programs. Medicare beneficiaries should contact their insurance company to learn more.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, there are a number of best practices for choosing a weight loss program.

• Talking openly and honestly with a health care provider, primary care doctor, or other health care professional about any weight concerns

• Starting a weight loss program that focuses on lifestyle habits (not just diet)

• Finding a routine that can be stuck to long-term

• Staying patient and practicing self-compassion