Medicare and gastric bypass – what you need to know
People tend to often ask if medicare covers gastric bypass surgery and this article will be providing every answer to this question. Not only that, this article will also provide the procedures for medicare coverage.
First off, gastric bypass is one of the most popular and successful types of bariatric surgery. It includes a cascade of procedures performed on people who are obese.
What is gastric bypass?
Gastric bypass is medically known as Rouxen-Y. It is a type of bariatric surgery that involves bypassing parts of the gastrointestinal tract to aid in weight loss.
Gastric bypass surgery involves 2 stages;
- The first stage involves sectioning off the top of the stomach, this procedure is done by creating a small pouch of one ounce in volume at the top of the stomach.
- The second stage involves dividing the small intestine into 2 parts. The first part, which is the bottom portion of the divided small intestine, is connected to the new stomach pouch.
The second part which is the top portion of the divided small intestine is reconnected further down the bottom portion of the small intestine.
Types of gastric bypass surgery
- Open gastric bypass;
This surgery is performed using a large incision in the abdomen and is typically invasive.
- Laparoscopic gastric bypass
This surgery is performed using a laparoscope and is typically much less invasive.
The purpose of gastric bypass surgery is to create a “bypass” of the normal functions of the digestive system which significantly reduces the amount of food a person consumes. It also decreases caloric intake as well as the absorption of nutrients.
Decreased food intake and absorption of food from gastric bypass support long-term weight loss.
Thousands of people undergo bariatric surgeries like gastric bypass each year and some of these people are Medicare beneficiaries.
Does this mean medicare covers gastric bypass? Yes, it sure does but there are some requirements you must meet before you undergo medicare- covered gastric bypass surgery.
When does Medicare cover gastric bypass?
For a person to carry out a gastric bypass surgery covered by Medicare, he or she needs to have certain health conditions related to obesity.
A study from 2018 showed that gastric bypass surgery is seen as one of the most popular bariatric surgery options for medicare beneficiaries.
The CMS (centers for medicare and Medicaid services) stated that Medicare covers gastric bypass surgery for beneficiaries who meet the following criteria;
- A body mass index (BMI) of 35 or higher
- Have at least one obesity-related comorbid condition
- Must have had a previous unsuccessful attempt at losing weight through medical treatments.
The certain health conditions related to obesity a person must meet as medicare criteria for gastric bypass surgery includes;
- Heart disease
- Gallbladder disease
- High blood pressure
- High cholesterol
Medicare requirements can most times vary based on state and individual insurance providers. However, if you meet the requirements stated by the CMS, you would have to provide the following information;
- Results of thyroid, adrenal, and pituitary blood tests show all the results in a standard range.
- A psychological evaluation result
- Proof of participation in at least one unsuccessful medical weight loss program, and
- A doctor’s referral for gastric bypass surgery.
What does Medicare covering gastric bypass surgery entail?
This is asking if all the tests and examinations before the surgery will be covered by Medicare. Let’s get into details;
Medicare will cover both open and laparoscopic gastric bypass surgery. However, the gastric bypass surgery must be performed at a facility that is certified by the American college of surgeons or the American Society for Bariatric Surgery.
The Medicare coverage of gastric bypass surgery will include the diagnosis, procedure, and recovery. In detail, this includes;
- Lab testing and examination before surgery
- Surgical services during the procedure
- Hospital room and board after the procedure
- Additional testing or blood work after the procedure
- Medications and durable medical equipment during recovery
- Routine checkups with a doctor during recovery
How much does gastric bypass surgery cost?
The cost of gastric bypass surgery is often dependent on the location of the hospital you are visiting. The surgeon carrying out the procedure, whether the patient is an inpatient, outpatient, or has another form of health insurance.
Is gastric bypass surgery effective?
Gastric bypass surgery is known as the most effective surgery for long-term weight loss although it is usually an option considered when a person has had other unsuccessful medical weight loss options.
This is because the surgery isn’t recommended for anyone and as earlier said, people who are qualified for gastric bypass surgery are individuals with a wide range of comorbidities related to obesity.
Tips to consider when preparing for a gastric bypass surgery
- Choose a Medicare advantage plan preferably when planning to undergo a gastric bypass surgery as the normal medicare plan doesn’t guarantee that all your bills may be covered.
A Medicare Advantage plan covers more of your bills preventing you from spending as much as you would have on a normal Medicare coverage plan.
Gastric bypass surgery can be covered by Medicare, however certain requirements must be met for this to take place.
You must get all the necessary information about what the coverage entails, the benefit of having a Medicare advantage plan, and what edge It has over been under a regular medicare coverage for the operation.
We hope this article is helpful to you if you are planning to undergo gastric bypass surgery soon.