Obesity Treatment and Medicare: A Guide to Understanding Coverage

Obesity is a chronic disease affecting 42% of adults in the U.S. alone, including a disproportionate share of racial and ethnic minorities. A survey by the Centers for Disease Control and Prevention (CDC) found that non-Hispanic Black adults had the highest age-adjusted prevalence of obesity at 49.6%, followed by Hispanic adults at 44.8%.¹

The consequences of obesity go well beyond physical appearance. People who carry extra weight are at risk for heart disease, stroke, and type 2 diabetes, according to the CDC. In one study, older adults aged 65-74 were found to have lower health-related quality of life scores due to increased body mass index (BMI).² 

Obesity is linked with added costs, too. In one study, the aggregate medical cost due to obesity among adults in the United States was $260.6 billion. Furthermore, the medical costs increased significantly with class of obesity, from 68.4% for class 1 to 233.6% for class 3. ³

While obesity is a serious issue in older adults, the good news is that it’s treatable. If you are living with obesity, you should know there is a treatment option that’s right for you. Treatment encompasses a range of interventions such as lifestyle and behavior changes, pharmacotherapy, and surgical weight loss procedures.

Medicare does cover some obesity treatments such as Intensive Behavioral Therapy and bariatric surgery, but it does not cover anti-obesity medications. Coverage also depends on what kind of Medicare plan you have.

What Obesity Treatments Does Medicare Currently Cover?

The Medicare Part B program recently took a major step forward in encouraging doctors and patients to view obesity as a significant health problem. Through its Intensive Behavioral Therapy for Obesity initiative, beneficiaries with a BMI of 30 or higher can receive no-cost obesity screenings and behavioral counseling. These services must be provided by a physician, nurse practitioner, physician’s assistant, or clinical nurse specialist and may include:

With the Intensive Behavioral Therapy program, Medicare only covers appointments that take place in a primary care setting. If your provider refers you to another specialist (i.e. a registered dietitian nutritionist), you’ll have to pay for those services out of pocket.

Some Medicare Advantage (Part C) plans provide enhanced coverage that can support your weight loss efforts. These coverages may include gym memberships and subscriptions to fitness programs such as SilverSneakers® GO™—a fitness app designed for older adults. Certain Medicare Advantage plans may also cover healthy home meal delivery for a limited time.

In cases of severe obesity (BMI of 35 or higher), Medicare covers bariatric surgery if it’s determined by your doctor to be medically necessary. In order to secure coverage, you'll typically need to have a qualifying BMI and at least one underlying obesity-related health condition, such as diabetes or heart disease. You must also show that you've tried to lose weight in the past through dieting or exercise and have been unsuccessful.

The types of bariatric surgery covered by Medicare include:

Some bariatric procedures are specifically excluded by Medicare, such as open sleeve gastrectomy and gastric balloon. It's important to know that even with a covered bariatric procedure, you'll still be responsible for standard costs such as co-payments for doctor's visits and unpaid deductibles.

What Obesity Treatments Are Not Covered by Medicare?

Many common weight loss interventions are not fully covered by Medicare. These include:

Anti-obesity medications (AOMs), or pharmacotherapeutics, are also not covered by Medicare. These medications are increasingly recognized as an effective option for some individuals, especially those who carry significant excess weight and have not been able to lose weight through lifestyle and dietary changes alone. However, the Medicare law currently omits AOMs from the Medicare Part D prescription drug benefit program. This is due to a provision that excludes drugs labeled as “weight loss” or “weight gain” agents.

Since this Medicare Part D exclusion was created, the medical community has come a long way in understanding obesity and its far-reaching health implications. In fact, in 2013, the American Medical Association (AMA) officially recognized obesity as a disease. AOMs are not used exclusively for the purpose of shedding pounds. They serve to treat a serious chronic condition as well as its many comorbidities that can negatively impact an older adult’s well-being and lifespan, such as high blood pressure, high cholesterol, heart disease and type 2 diabetes.

Drug therapy is a key treatment component for certain groups of older adults living with obesity. It can be used to complement other treatment approaches covered by Medicare and enhance the individual’s success. Medicare’s non-coverage of AOMs creates a gap in the continuum of care. It also limits treatment choices for beneficiaries, which can pose challenges for patients with low income.⁴

Expanding Medicare Coverage for Adults With Obesity

Including FDA-approved medications and other anti-obesity treatments in Medicare coverage would help more older adults actively manage their weight and reduce their health risks. Providing access to diverse therapy options is an essential part of equitable, person-centered care delivery. Certain advocacy groups, such as the Obesity Action Coalition (OAC), are currently working on legislation to broaden access to treatment options for Medicare beneficiaries affected by obesity. For example, the Treat and Reduce Obesity Act (TROA) is a bipartisan bill designed to enable CMS to clarify that FDA-approved anti-obesity medications may be covered under Part D.

Want to Do More?

Visit ObesityAction.org to find out how you can help support the 2021 Treat and Reduce Obesity Act (TROA). This bill includes expanded Medicare coverage for obesity, including FDA-approved medications for chronic weight management.

Leverage the Obesity Bill of Rights, a set of 8 patient-centered principles established so that people with obesity will be screened, diagnosed, counseled, and treated according to medical guidelines and no longer face widespread weight bias and ageism within the health care system or exclusionary coverage policies by insurers and government agencies. Launched on Jan. 31, 2024, the Obesity Bill of Rights is endorsed by nearly 50 national obesity and chronic disease organizations. Find out more at right2obesitycare.org.

Need Help Navigating Your Medicare Options?

If you need help sorting through your options, NCOA has a trusted partner that is committed to serving your Medicare selection needs and priorities at no cost to you. Our process connects you with licensed Medicare enrollment specialists backed by our decades-long commitment to helping older adults thrive. 

Sources

1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no. 360. Hyattsville, MD: National Center for Health Statistics; 2020.

2. Reinbacher et al. The Impact of Obesity on the Health of the Older Population: A Cross-Sectional Study on the Relationship between Health-Related Quality of Life and Body Mass Index across Different Age Groups. Nutrients 2024.  Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10780898/

3. Crawley et al. Direct medical costs of obesity in the United States and the most populous states. J Manag Spec Pharm. March 2021. Found on the Internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10394178/

4. Coverage of Anti-Obesity Medications is Consistent with the Medicare Part D Statute (White Paper).