Does Medicare Cover Weight Loss Programs?

Original Medicare may cover some weight management services but doesn’t generally cover weight loss programs, services, or medications. It may cover weight loss surgery if you meet eligibility criteria.

According to a 2013–2016 survey by the Centers for Disease Control and Prevention (CDC), almost half of U.S. adults attempted to lose weight during the 12 months before the survey.

In addition to diet and lifestyle changes, weight loss programs can help people who want to lose excess weight. However, Medicare only covers weight loss programs when deemed “medically necessary.”

In this article, we’ll explore when Medicare covers weight loss programs, what services Medicare covers, and how to get the best Medicare coverage to help you maintain a moderate weight.

Does Medicare offer coverage for weight loss programs?

While Medicare offers various preventive services to help you attain a healthy weight, it generally does not cover weight loss services, programs, or medications. That means you would pay out of pocket for services including:

• Services such as meal delivery for weight loss
• Programs such as Nutrisystem or Weight Watchers
• FDA-approved diet pills or medications

However, original Medicare will provide preventive weight loss screenings and nutrition counseling if you meet the eligibility criteria. Some Medicare Advantage (Part C) plans offer additional health and wellness services, like fitness programs and gym memberships.

What weight loss services are covered by Medicare?

Medicare doesn’t offer weight loss services for all enrollees. It only covers weight loss services necessary for a medical procedure, such as those required to prepare for bariatric surgery or as part of your preventive care.

Obesity screenings and counseling

If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling.

Your doctor or primary care physician must perform these preventive services in a doctor’s office or primary care setting. They include:

• Obesity screening
• Dietary assessment
• Nutrition counseling

Obesity screenings and behavioral counseling are considered preventive services covered under Medicare Part B. If you’ve met your Part B deductible for the year, most of these services will cost you nothing out of pocket.

Nutritional counseling

Doctors may recommend medical nutrition therapy (MNT) to treat and manage certain health conditions, such as diabetes or kidney disease. This type of therapy includes:

• Nutrition and lifestyle assessment
• Nutritional therapy sessions
• Lifestyle management
• Follow-up visits

Medicare will cover MNT if you have either of the conditions mentioned above or have had a kidney transplant within the last 36 months. People on dialysis can also receive MNT as part of standard care. MNT is considered preventive, so these services have no out-of-pocket cost. However, your doctor must refer you to a registered dietitian for counseling.

Fitness programs

Original Medicare doesn’t cover gym memberships or fitness programs. However, some Medicare Advantage plans offer health and wellness benefits that cover these types of services. These may include:

• SilverSneakers: one of the most popular fitness programs for adults age 65 and older
• Renew Active: a program by UnitedHealthcare that covers gym memberships and other health and wellness programs and events
• Silver&Fit: another fitness program that offers nationwide services both in-person and online

Before you enroll in a Medicare Advantage plan, check what coverage it offers for these programs. Depending on the company, plans that include this type of coverage might have additional costs. If you have original Medicare (parts A and B), these programs are not covered by Medicare. You’ll pay the full price of these services out of pocket.

Weight loss surgery

For some people, bariatric surgery may be medically necessary for extreme weight loss. While Medicare doesn’t cover weight loss surgeries for appearance reasons, it will cover bariatric surgery if you meet the following criteria:

• A BMI of 35 or higher
• At least one underlying health condition related to obesity
• Previous unsuccessful medical attempts at weight loss

Medicare coverage of these procedures includes both malabsorptive and restrictive bariatric procedures, such as:

• Roux-en-Y gastric bypass
• Biliopancreatic diversion with duodenal switch
• Adjustable gastric banding
• Sleeve gastrectomy
• Vertical gastric banding

Medicare will cover bariatric surgery if you meet the eligibility criteria listed above. However, you’ll owe the standard Medicare plan costs for the procedure, which may include:

• Any deductibles you haven’t already paid
• Copayments for doctor and specialist visits
• Coinsurance for any procedures

What isn’t covered?

Unless preventive or medically necessary, most weight loss interventions aren’t covered by Medicare. Noncovered weight loss interventions may include:

• Weight loss programs such as Weight Watchers or Nutrisystem
• Weight loss procedures purely for aesthetic purposes, such as liposuction
• Weight loss medications, including FDA-approved medications

Although Medicare does cover most bariatric surgery procedures, it doesn’t cover the following bariatric procedures:

• Gastric balloon
• Intestinal bypass
• Open adjustable gastric banding
• Open sleeve gastrectomy
• Laparoscopic sleeve gastrectomy
• Open vertical banded gastroplasty
• Laparoscopic vertical banded gastroplasty

If you enroll in any of these noncovered programs or undergo any of these services, you may pay the full cost out of pocket. These costs can range from less than $23 per month for programs like Weight Watchers to around $4,000 for procedures like liposuction.

How can I get the most coverage for weight loss management?

Medicare enrollees interested in extra health and wellness coverage for weight loss can compare Medicare Advantage plans in their area. Most Medicare Advantage plans offer additional coverage beyond what original Medicare covers — especially for perks such as fitness programs and gym memberships.

If you meet the coverage criteria above for weight loss surgery, you don’t need to enroll in a Medicare Advantage plan to be covered for these services. They’ll be covered under your original Medicare plan. However, if you want additional long-term support after surgery, Medicare Advantage plans may offer these health and wellness perks.

Even if your Medicare plan doesn’t cover the weight loss services you’re interested in, there are some dietary and lifestyle changes you can make on your own, including:

• Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, and healthy fats. Focus on lean protein and eat red and processed meats in moderation.
• Enjoy refined carbohydrates, such as sweets and soda, in moderation. These foods have low nutritional value and often replace more nutritious options.
• Drink water often and make it your primary drink throughout the day. Soda, alcohol, and other beverages are OK in moderation but can add extra calories.
• Find a diet that works for you in the long term, and avoid overly restrictive or dangerous fad diets. Always consult your doctor before making any major dietary changes.

The takeaway

Weight loss programs can offer a great support system to help you meet your weight loss goals. However, original Medicare won’t cover most weight loss services unless they’re preventive or your doctor has decided that they’re medically necessary for your situation. If you want Medicare coverage for these extra services, such as gym memberships and fitness programs, you’ll need to find a Medicare Advantage plan that meets your needs.