Does Medicare Cover Gastric Sleeve Surgery? 

In recent years, statistics collected in the United States showed that over 41 percent of adults over the age of 60 had a body mass index over 30 and were medically considered to be obese. 

Not only does obesity cause physical discomfort and make daily life activities more difficult, but it is also a dangerous health condition that can raise your risk for a long list of diseases and illnesses such as:

• Type 2 diabetes 
• Heart disease
• Stroke
• Fatty liver disease
• Certain types of cancer
• Osteoarthritis
• Premature death

Because of the high risk of health complications from obesity, some patients may discuss many  gastric sleeve or gastric bypass surgery with their physician. These types of bariatric surgery may be safe and beneficial for seniors, but it depends on your own personal health needs and health history. 

A gastric sleeve procedure is a surgical procedure that removes a large portion of the stomach. The remaining part of the stomach, shaped like a long, slim tube, restricts the amount of food and liquids that you can take in comfortably over a certain amount of time. 

Physicians or surgeons can perform a gastric sleeve procedure laparoscopically, by making small incisions in the abdomen and using special roboticized instruments. This type of surgery is less invasive, has a faster recovery time, and your Medicare insurance may cover part of the expenses.  

Does Medicare cover gastric sleeve surgery? 

Medicare typically covers certain bariatric surgical procedures such as gastric bypass or laparoscopic banding surgery for those who qualify. 

To qualify for this coverage, you must meet the following criteria:

• Your body mass index (BMI) must be over 35
• Your physician must certify that you have at least one medical condition that’s related to your obesity, such as diabetes, high blood pressure, fatty liver disease, etc. 
• You must have been obese for at least the past five years.
• You must have been enrolled in a medically supervised weight loss program without a successful outcome of weight loss. 

If you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), your coverage depends on where you have the surgical procedure done. 

Medicare Part A covers your surgery if your physician (who accepts Medicare assignment) orders you to be admitted as an inpatient to undergo the procedure in a hospital that accepts Medicare assignment.  Part A covers the cost of the procedure and your inpatient stay after you pay the deductible for the benefit period. 

If you have your gastric bypass as an outpatient, your procedure is covered by Original Medicare Part B if you qualify. Part B pays 80 percent of the final Medicare-approved amount, and you pay 20 percent after your annual deductible has been paid. 

If you’re enrolled in a Medicare Advantage (MA) plan sold by a private insurance company, your provider must cover all benefits provided by Original Medicare Parts A and B. Depending on the MA plan you have, you may have additional benefits as well. Depending on the type of plan, you may need to use in-network providers for your care to get coverage. 

Through a Medicare Advantage plan, your coinsurance or copayment charges may be different than those through Original Medicare Parts A and B. Contact your provider if you aren’t sure about how much you’ll pay out-of-pocket for your gastric sleeve procedure. 

How much does gastric sleeve surgery cost without Medicare coverage? 

The cost of gastric sleeve surgery varies depending on where you have the procedure, who performs it, and how long you stay in the hospital. Across the country, prices range between $7450 to $33,541, but the average price is approximately $14,400.