Healthcare Educators


Medicare and Weight Loss: What Is Covered?

by | Feb 5, 2024

As with Americans of every age, obesity rates in seniors have risen dramatically in recent years. Two in five people over the age of 65 are obese. Older adults who are overweight face higher risks of chronic disease and illness, such as diabetes, heart disease, cancer, high blood pressure, and high cholesterol. These chronic conditions lead to higher rates of disability and premature death.

If you are trying to achieve a healthier weight, there are a few things you need to know about your Medicare benefits.

New Weight Loss Drugs

You have no doubt heard a lot about the success of new weight loss medications like Wegovy and Ozempic and may be wondering if they are right for you. Currently, Medicare only covers these medications when prescribed for diabetes. It does not cover them for weight loss, due to a decades-old law that prevents Medicare from covering any drugs prescribed for weight loss or weight gain.

Congress is currently considering whether Medicare should be allowed to cover these drugs. The drugs are expensive – costing approximately $1,300 a month – which means most people will find them unaffordable without insurance coverage. Congress must consider any increase in federal spending that would result from covering the drugs. Increased spending could result in a higher Part B premiums for all Medicare beneficiaries.

Further studies are necessary to better understand the risks and side effects of these new medications in older adults. Reported side effects include:

  • Nausea and stomach upset.
  • Bone and muscle loss, which increases frailty, the risk of falling, and fractures – a serious concern for seniors trying to maintain their independence and mobility.
  • Insufficient nutrient and fluid intake – The drugs work by decreasing appetite, which means some seniors may struggle to consume enough nutrients and fluids.
  • Sharp blood pressure drops, increasing the risk of lightheadedness and falling.

Some experts believe it’s likely the medications will receive limited approval in the near future for individuals who suffer from obesity along with another chronic health condition.

What Medicare Does Cover for Weight Loss

Medicare does cover some benefits to support your weight loss efforts:

Annual Wellness Visit – If you have concerns about your weight, your Annual Wellness Visit with your primary care doctor is a great place to start. Your doctor can help you create a nutrition and exercise plan specific to your individual needs.

Behavioral Therapy – Medicare covers an obesity screening, dietary assessment, and counseling with your primary care doctor in full if you have a BMI (body mass index) of 30 or higher.

Dietician – Medicare covers a nutrition and lifestyle assessment with a registered dietician in full for those with qualifying health conditions, such as diabetes or kidney disease.

Bariatric Surgery – Medicare covers gastric bypass surgery and laparoscopic banding for individuals who qualify. Your surgery must be medically necessary and you must show you have unsuccessfully tried to lose weight through diet and exercise. Deductibles, coinsurances, and copays may apply, depending on the type of plan you have. It’s important to talk to your doctor about the risks of these surgeries in older adults.

Wellness Benefits – If you have a Medicare Advantage plan, you may have wellness benefits, such as a gym membership.

Do you have questions about what benefits your Medicare plan covers? The experienced team at Healthcare Educators is here to help. Contact us today.