Does Medicare Cover Xenical? 

Most seniors know that eating healthy and getting plenty of exercise are the keys to maintaining a healthy weight, but for some people, this can be challenging. Aside from the temptation to overeat or indulge in unhealthy foods, some seniors live with medical conditions that make it more challenging to lose weight and keep it off. Unfortunately, these people may be at a higher risk for heart disease and may experience difficulty getting around.

In fact, mobility challenges are part of the equation when it comes to the senior population and weight management. If your body begins to experience more difficulty with movement, you may remain more sedentary. As time goes by, a sedentary lifestyle contributes to weight gain. As someone puts on more weight, it becomes more difficult to move and the cycle continues.

Weight management for seniors

Although only your doctor can provide you with specific recommendations, a healthy diet and exercise are usually the first course of treatment for weight management concerns in seniors. If mobility or other health challenges present barriers to regular exercise or a healthy diet, medications like Xenical may be prescribed.

What is Xenical?

Xenical is a prescription medication designed for weight loss. Xenical’s generic alternative  orlistat is available as an over-the-counter (OTC) medication in a lower strength. As a lipase inhibitor, Xenical prevents enzymes from breaking down fats in the body. Instead, some of the fats are passed along through the digestive system for elimination. This prevents them from being processed and accumulated by the body.

Does Medicare cover Xenical?

Because weight management is an important topic for seniors, many wonder if Medicare covers Xenical. In most cases, Medicare benefits are available for prescription medications through Medicare Part D. This is the prescription drug benefit of Medicare insurance, and it covers medically-necessary medications prescribed by your doctor.

Unfortunately, Medicare coverage is not available for Xenical as the medication does not fall within Medicare’s requirement for medical necessity. Medicare benefits do not cover medications designed for weight loss since the Centers for Medicare & Medicaid Services (CMS) views these medications as pertaining only to lifestyle and not medical necessity.

When it comes to the OTC version of Xenical, orlistat, Medicare recipients will once again have to pay out of pocket. Original Medicare coverage is not available for OTC products, including weight loss drugs or supplements.

Do Medicare Advantage plans cover Xenical?

Medicare Advantage plans provide the same benefits available as Original Medicare, but many offer benefits that fall beyond the scope of Original Medicare. Most MA plans include prescription drug coverage, but weight loss drugs may not qualify for coverage. Some MA plans offer an over-the-counter allowance, while some plans offer access to fitness programs like SilverSneakers.

Does Medicare cover weight loss surgery?

Although Medicare benefits do not apply toward the purchase of Xenical and other weight loss drugs, Medicare recipients may be able to obtain coverage for weight loss surgery if it is deemed medically necessary. Medicare Part B offers coverage for outpatient care, including surgery. Medicare recipients only pay a 20% coinsurance for outpatient services covered under Medicare Part B after meeting their deductible.

The key to obtaining Medicare coverage for weight loss surgery is that your doctor must deem the surgery medically necessary to preserve your life and prevent serious harm to your health. If you are seeking weight loss surgery for cosmetic reasons, your procedure will not be covered.