Does Medicaid Cover Weight Loss Programs?
The information in this article is current as of February 16, 2022.
As of 2021, more than 82 million Americans enrolled in the CHIP or Medicaid programs within their state. If you’re one of the many Americans enrolled in Medicaid, you might be wondering, “Does Medicaid cover weight loss programs?”
Medicaid can cover several things related to weight loss but may depend on your health situation and state’s Medicaid coverage. Depending on specific requirements, this can include weight loss surgery, weight loss medications, supplements and vitamins, weight loss programs, obesity or bariatric screenings, and counseling. In this article, we’ll review these in detail. This way, you can get the coverage you need.
How Medicaid Coverage Works
Before discussing which Medicaid covers weight loss programs, we’ll review how Medicaid coverage works. This way, you can understand whether this government program covers you.
Medicaid coverage must include mandatory benefits. These are benefits that the government requires each state to offer through their Medicaid program. You have the right to mandatory benefits if enrolled in Medicaid, meaning that you’ll have access to these benefits no matter where you’re based.
Optional Medicaid Benefits
States have flexibility once a recipient meets the mandatory benefit based on the terms of the Medicare program within their state. That’s what’s known as optional Medicaid benefits.
For this reason, Medicaid weight loss program coverage can vary by state and are available as optional Medicaid benefits.
It’s essential to check some things specifically within your state. First, check which weight loss programs are considered or covered as mandatory benefits. Then, check which ones are available as optional benefits (if at all).
Will Medicaid Cover My Weight Loss Surgery?
When it comes to weight loss or bariatric surgeries, you may be able to get coverage through Medicaid for procedures such as:
- Gastric sleeve surgery
- Lap band surgery
- Gastric bypass
However, coverage for these weight loss procedures only occurs if you meet specific requirements. We’ll review these now.
- You must either be a male over 15 or a female over 13.
- Your BMI must be over 35 and have a minimum of one comorbidity.
- Comorbidity examples include diabetes, high cholesterol, high blood pressure, and sleep apnea.
- BMI requirement is different if you’re younger than 21 — in this case, you must have a minimum of one comorbidity, and your BMI must be greater than 40.
- A doctor must write a letter stating that the surgery is medically necessary to reach a healthy weight and maintain it.
- You must pass a psychological exam.
- You must have additional documentation demonstrating that you tried, unsuccessfully, to use standard treatment to manage your weight.
Additional Requirements (and Disqualifications)
There are additional requirements, as well as disqualifications. For example, another condition is completing a six-month weight loss program. This weight loss program must be medically supervised and occur within a year of the surgery—and you must also provide documented proof of this.
You must clearly understand that your lifestyle and diet will change after the surgery.
After and before the surgery, psychological and nutritional services have to be made accessible to you.
Several things can disqualify you from getting Medicaid coverage for weight loss surgery, including:
- Long-term steroid use
- Chronic pancreatitis
- Inflammatory bowel disease
Coverage could be disqualified if you receive any psychological treatment that interferes with your post-operation lifestyle changes.
The surgery has to occur within a Bariatric Center for Excellence. Additionally, the coverage for this surgery can vary from state to state.
Will Medicaid Cover My Weight Loss Medications?
While they aren’t a mandatory benefit under the Medicaid program, many state Medicaid programs will have optional Medicaid benefits coverage for weight loss pills. As for prescription drugs that can help manage weight or related health conditions, Medicaid offers coverage for many.
When it comes to supplements or vitamins, you can find out more about getting them with your SNAP card here.
Does Medicaid Cover Weight Loss Programs?
If you’re wondering, “Does Medicaid cover weight loss in terms of programs?” the answer is that this depends. When it comes to Original Medicare, which includes Medicare Part B and Part A, you will not be covered for them because they count as elective lifestyle programs.
However, you can get coverage for services like nutrition therapy or obesity counseling provided to you by a dietitian.
Medicare Advantage, which includes Medicare Part C, offers Original Medicare coverage and offers you additional benefits, which often include free gym memberships.
Get more information here to learn more about the best free weight loss programs.
Some state Medicaid programs will cover gym memberships to assist beneficiaries with losing weight and staying healthy. However, you may want to contact them directly to be sure.
Also, different Medicare Advantage plans offer different types of coverage. You can research and compare plans near you that offer weight loss program coverage.
All you have to do is put in your zip code. Then, you can take a look at the different plans available, choose one on the phone or online, and start your program. You can also use this comparison website in Spanish.
Will Medicaid Cover My Obesity Screening?
For beneficiaries of Medicaid younger than 21, obesity screenings are a mandatory benefit. In addition, the government requires all Medicaid programs in every state to cover the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
It is a mandatory benefit that can vary by state. However, some states will offer this benefit to Medicaid beneficiaries and 21 or over.
However, if you’re 21 or older and want to get an obesity screening, check with your state’s Medicaid program.
Will Medicaid Cover My Counseling and Screenings?
For beneficiaries with a BMI of 30 or greater, Medicare might offer coverage for the behavioral therapy and obesity screenings. A maximum of two screenings for diabetes and a BMI screening are covered every year.
Additionally, there’s coverage for nutritionist counseling to help you with exercise and diet, as well as coverage for dietary assessments.
Diabetes Prevention Program
For people who meet specific criteria, Medicare provides a Diabetes Prevention Program. This program, which lasts six months, includes 16 sessions. It includes strategies, tips, and training for healthy weight management and weight loss.
Once you’ve completed the first six months, there are six more months that include less intense follow-up sessions. Then, there are 12 months of ongoing maintenance sessions.
Medical Nutrition Therapy
Medical Nutrition Therapy, or MNT, is also available through Medicare, depending on the health situation of the beneficiaries. For example, beneficiaries who have had a kidney transplant (within 36 months), kidney disease, or diabetes will receive coverage.
Services available through MNT include follow-up visits for diet monitoring, help with managing healthy weight loss and lifestyle factors, nutritional therapy, and a lifestyle and nutrition assessment.
Losing Weight With Medicaid Benefits
In this article, we’ve answered the question, “Does Medicaid cover weight loss programs?” In addition, we’ve reviewed the differences between mandatory and optional benefits and whether Medicaid covers weight loss surgery or weight loss medications.
We’ve also reviewed whether it covers weight loss programs, obesity screenings, and counseling and screenings.
Now that we’ve reviewed the ins and outs of weight loss-related benefits you can receive through Medicaid, you can figure out which benefits to get and through which Medicaid program.
Finally, you can get closer to your weight loss goals without having to spend too much money doing so.
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