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How Important Is Weight Control For Medicare beneficiaries?
Medicare beneficiaries agrees that being overweight is a concern. In fact, in 2004 Medicare expanded their coverage for weight loss interventions. They will now cover proven weight loss programs, including weight loss surgery.
How Does Obesity Affect Your Health?
According to health experts, an estimated 20% of U.S. adults over 65 are obese and another 40% are overweight. The extra pounds substantially increase the risk for diabetes, hypertension, heart disease and other illnesses. In addition, studies have consistently shown that even small reductions in weight and increases in physical activity can improve your health and help you feel better.
Why Is It Harder for Medicare Beneficiaries to Lose Weight?
Losing weight is a challenge for anyone. For some Medicare beneficiaries, however, the challenges are much more complicated. For example, a large number of people over 65 are dealing with multiple health problems. They may have high blood pressure, diabetes, heart disease, kidney problems or all of the above. In addition, seniors have many more barriers to overcome than their younger counterparts.
Those individuals receiving Medicare due to a disability may share many of the obstacles faced by the senior population, as well.
- Physical barriers can include:
- Joint pain that makes it difficult to move.
- Balance problems that increase the risk of falling.
- Vision problems that make it harder to move in unfamiliar locations.
- Concerns about safety when exercising outdoors.
- Lack of mobility.
Barriers to dietary change:
- Reduced ability to taste, which tends to lure individuals toward foods higher in calories because of their sweet and/or salty taste.
- Long-term eating habits that are harder to change.
- Limited income: reduced ability to pay for expensive diet foods.
Other barriers:
- Many beneficiaries take medications that increase weight or make it impossible to lose it.
- Older adults tend to lose weight more slowly than younger adults.
- Multiple health issues that limit the types of foods they can eat and complicate dietary and exercise recommendations.
The good news is that safe and successful dieting in the older population is possible. It requires health professionals who understand the challenges faced by Medicare beneficiaries and know how to overcome them. The effort it takes is well worth it, since weight loss and a moderate exercise program have been shown to help improve health and well-being.
Does Medicare Cover Weight Loss Programs?
Yes, under certain conditions, Medicare will cover weight loss programs.
How Do I Qualify for Coverage Under Medicare?
Medicare will cover certain weight loss services and programs:
- When weight loss is a necessary part of treatment for diseases such as hypothyroidism, Cushing's disease, hypothalamic lesions, cardiovascular diseases, respiratory diseases, diabetes, and hypertension (and others)
- Before surgery, when the weight loss is necessary to reduce possible complications posed by obesity
To qualify, you must be under the care of a doctor. The doctor must write an order (prescription) for the services and the need for the services must be documented in your medical records.
If you get your coverage from a Medicare Advantage Plan, call your plan and ask about qualifying for weight loss services. Your plan may offer additional services.
What Does Medicare Cover?
Medicare will cover the following:
- An initial assessment of your eating and activity habits
- Counseling on diet and physical activity
- Education on how to improve your diet and changes that will help you lose weight and improve your health
- Follow-up visits to monitor your diet and weight loss progress
Important things to know:
- Medicare will cover up to three hours of individual counseling services the first year, and two hours each year after that.
- If your condition or treatment needs changing, you may be able to receive more services. Your doctor must write an order (prescription) for the additional services each year they are needed.
- You must receive the services from a qualified health professional who is Medicare-certified.
- If you get your care from a Medicare Advantage or MediGap/Medicare Supplemental Plan, your plan may offer additional coverage.
What Will It Cost Me?
Your out-of pocket cost will depend on the type of Medicare plan you have. For example:
- Medicare covers 80% of the approved amount for the service; you are responsible for the remaining amount.
- If you have a MediGap/Medicare Supplemental Plan, call to find out what is covered by the plan. With a MediGap plans you will pay little or nothing.
- If you have a Medicare Advantage Plan, call the plan for information on coverage. Remember the plan must cover at least what Medicare does; many MA Plans cover more.
How Do I Find a Provider?
If you are interested in losing weight, you should go to your doctor and ask for recommendations. The doctor will be responsible for monitoring your program and documenting your progress, and will likely have an ongoing working relationship with local providers or have them on staff.
If you get your coverage from a Medicare Advantage or MediGap/Medicare Supplemental plan, you may have to use the providers they have on contract.
Getting Care Through Original Medicare
Ask your doctor, friends and family for recommendations and do your homework. Before you choose a provider, ask:
- If they are participating providers
- If they accept assignment
- Ask them to write down what the charges are and how much you will have to pay
If your supplier does not accept assignment:
- They can charge more than the Medicare-approved amount.
- They can ask you to pay the entire cost of your services when you receive them.
- You may have to bill Medicare on your own and wait for reimbursement. It can take several weeks.
Other Important Things to Know
If the supplier is not enrolled in Medicare, Medicare will not pay the claim.
You must have paid your annual deductible before Medicare will begin to pay its share.
A signed and dated order (prescription) must be on file with the provider.
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