Obesity is recognized as a medical condition, and Medicare provides coverage for specific weight management services. Coverage is generally limited to services considered medically necessary or preventive, primarily falling under Medicare Part B for counseling and Part A or B for certain surgical interventions. Beneficiaries must meet strict medical criteria to qualify, as many popular commercial programs remain outside the scope of standard Medicare benefits. Understanding these defined services and eligibility rules is essential for individuals seeking Medicare support for weight loss.
Covered Intensive Behavioral Therapy Services
Original Medicare Part B covers Intensive Behavioral Therapy (IBT) for obesity, a preventive service designed to promote sustained weight loss through changes in diet and exercise. This structured counseling includes an initial obesity screening using Body Mass Index (BMI) measurement and a dietary assessment. IBT must be provided by a qualified primary care provider (e.g., physician, nurse practitioner, or physician assistant) within a primary care setting. Sessions are structured over a 12-month period, beginning with weekly sessions for the first month.
The next five months allow for one session every other week. If beneficiaries meet the required weight loss threshold, the coverage schedule continues into the second half of the year.
Qualifying for Medicare Weight Loss Counseling
To qualify for Intensive Behavioral Therapy (IBT) under Medicare Part B, an individual must have obesity, defined by a Body Mass Index (BMI) of 30 or higher. The individual must also be mentally alert and competent to participate in the behavioral therapy.
The coverage schedule is conditional on the beneficiary’s progress after the initial six months. To be eligible for continued monthly sessions during months seven through twelve, the individual must demonstrate a sustained weight loss of at least 3 kilograms (approximately 6.6 pounds) by the six-month mark.
If the minimum weight loss of 3 kg is not achieved, the monthly counseling sessions are discontinued. The beneficiary is eligible for a reassessment of their BMI after an additional six-month waiting period. This structure limits the total number of covered sessions to a maximum of 22 over a 12-month period.
Weight Management Coverage Beyond Original Medicare
While Original Medicare (Part A and Part B) covers specific behavioral therapy and medically necessary surgeries, coverage may expand under alternative Medicare options. Medicare Advantage plans (Part C) must cover all Original Medicare benefits, including Intensive Behavioral Therapy. These private plans often provide additional health and wellness benefits, such as gym memberships, fitness programs, or enhanced dietary counseling.
Coverage for weight loss medications is addressed through Medicare Part D, the prescription drug benefit. Federal law currently excludes drugs used solely for weight loss, meaning anti-obesity medications are not covered if prescribed for weight management alone.
However, a Part D plan may cover certain medications that result in weight loss if they are prescribed to treat an FDA-approved condition, such as type 2 diabetes or cardiovascular disease. Until the exclusion is reinterpreted, Part D only covers these medications if the prescription is for a qualifying, non-weight-loss-related medical condition.
Programs and Procedures Medicare Excludes
Many common weight loss methods are not covered by Original Medicare, requiring beneficiaries to pay the full cost out-of-pocket. This exclusion includes commercial weight loss programs, such as structured diet or meal delivery services like Weight Watchers and Nutrisystem. Medicare views these programs as lifestyle enhancements rather than treatments for a specific medical condition.
Medicare also does not cover:
- Health club memberships or gym fees.
- Most cosmetic procedures aimed at weight reduction, such as liposuction.
- Specialized dietary supplements.
- Non-medically necessary meal replacements.
- Most over-the-counter weight loss products.
While most non-surgical programs are excluded, Medicare covers certain bariatric surgeries under highly specific conditions. To qualify for procedures like gastric bypass or sleeve gastrectomy, a beneficiary must have a Body Mass Index of 35 or higher and at least one obesity-related health condition (e.g., diabetes or heart disease). Coverage is also contingent on the individual having previously been unsuccessful with non-surgical weight loss treatments and the surgery being performed at a Medicare-approved facility.