Does My Insurance Cover Weight-Loss Surgery and Programs?

Bariatric surgery is one of the most effective ways to achieve lasting weight loss. After surgery, people lose up to 60% of excess weight within 6 months and 77% within a year.

For many, insurance can help cover the cost—but approval isn’t guaranteed. Coverage depends on your plan and the type of procedure. Also, a healthcare professional may need to classify it as medically necessary. Meeting your insurer’s eligibility criteria is key.

Does my insurance cover weight-loss surgery?

Many insurance companies acknowledge the significant health risks associated with excess weight. That’s why they provide coverage for weight-loss surgery when qualifications are met. Coverage varies depending on your plan.

Private and employer insurance

Bariatric surgery is part of the Affordable Care Act’s essential health benefits. Individual and small-group insurance plans in 23 states must include coverage. But what if you live in a state without this mandate or you’re part of a large-group insurance plan? Your coverage depends on whether your insurer or employer includes bariatric surgery.

Medicare

Medicare covers certain weight-loss surgeries. These include laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. But you must meet Medicare’s criteria for morbid obesity and try other treatments first.

Medicaid

Medicaid coverage for weight-loss surgery and eligibility rules vary by state. For example, Colorado calls for a mental health evaluation. Illinois requires participation in a weight-loss program. Medicaid may also cover only certain weight-loss procedures depending on your state. Review your plan, or visit your state’s Medicaid website to learn more about your benefits.

Tricare 

Tricare covers several bariatric surgical procedures. These include Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. But you must meet certain Tricare requirements. This includes being at least 18 years old. Also, your medical records need to show past weight-loss attempts that didn’t work. The surgery must be considered medically necessary. 

Veterans Affairs benefits

Veterans may qualify for weight-loss surgery through their Veterans Affairs (VA) benefits. But they must meet specific eligibility criteria.

Veterans must complete a comprehensive presurgical evaluation. This may include a mental health assessment and medical tests. Having medical conditions that may risk complications from surgery could disqualify you. Veterans must also make prior attempts to lose weight through diet and exercise.

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What are the common requirements for insurance to cover weight-loss surgery?

If your insurance covers weight-loss surgery, you must meet the requirements. Ask a healthcare professional about your plan’s criteria before making an appointment.

Common weight-loss surgery requirements include the following:

• Be age 18 or older

• Have a body mass index (BMI) over 40 or a BMI over 35 with Type 2 diabetes, high blood pressure, or other risk factors

• Undergo psychological testing

• Complete smoking cessation before surgery

• Have made weight-loss efforts in the past

• No current substance use disorder

• Have a morbid obesity diagnosis for a period before surgery

• Finish an insurance-mandated weight-loss program

When will insurance not cover weight-loss surgery?

Many insurance plans cover bariatric surgery. But there are several reasons your procedure might be denied. Insurance is unlikely to cover weight-loss surgery in the following cases:

1. The procedure is deemed cosmetic rather than medically necessary

Insurers may need proof that weight-loss surgery is necessary to treat a serious medical condition. Examples include obesity-related diabetes, hypertension, and sleep apnea. Your case must meet their definition of medically necessary. If it doesn’t, coverage may be denied.

2. The surgery is not on the insurer’s list of covered procedures

Some plans cover only specific weight-loss procedures, like gastric bypass or sleeve gastrectomy. Others, such as gastric ballooning or open adjustable gastric banding, may be excluded.

3. You fail to meet the eligibility requirements for bariatric surgery

Insurance companies typically have BMI requirements for bariatric surgery. A BMI over 40 or a BMI over 35 with obesity-related health conditions is often needed. An insurer may also request a documented history of supervised weight-loss attempts. This includes diet and exercise programs.

4. You don’t complete the proper documentation for approval

Many insurers require a physician-supervised weight-loss program before approving bariatric surgery. Participation requirements typically range from 6 to 12 consecutive months, depending on the insurer’s specific guidelines. Missing medical records or incomplete paperwork may lead to a denial.

5. You choose an out-of-network professional to perform the procedure

Some insurance plans cover weight-loss surgery only if you use in-network professionals. This means your surgeon and hospital must be in their approved network. If you choose an out-of-network professional, you may be responsible for the full cost.

6. Your plan doesn’t cover any type of weight-loss surgery

Certain health plans, including some employer-sponsored and Medicaid programs, exclude bariatric surgery entirely. Always check your policy’s coverage details before starting the process.

Does insurance cover all types of weight-loss surgery?

Your insurance may cover only certain types of weight-loss surgery. For example, Medicare doesn’t cover laparoscopic sleeve gastrectomy. Check your plan to find out which types of bariatric surgeries are covered.

How much does weight-loss surgery usually cost?

Weight-loss surgery typically costs $7,000 to $33,000 before insurance. Your cost will depend on several factors. These include the procedure you choose and your location.

Does insurance cover skin removal after weight-loss surgery?

Insurers generally cover body contouring after significant weight loss from bariatric surgery. People with issues that affect their daily activities may also be covered.

Weight-loss programs covered by insurance

Weight-loss programs covered by insurance vary by provider. For example, Aetna’s coverage excludes WeightWatchers and similar programs. But Independence Blue Cross offers reimbursement for approved weight-management programs. Check your plan for details.

Does Medicare cover weight-loss programs?

Medicare does not cover nonsurgical weight-loss programs. That includes commercial weight-loss plans and fitness programs. But weight-management programs that are medically necessary to treat obesity may be covered. Some Medicare Advantage plans cover gym memberships or fitness programs, such as SilverSneakers and Silver&Fit.

Does Medicaid cover weight-loss programs?

Medicaid may cover certain nonsurgical weight-loss treatments. Examples include medical nutrition therapy and obesity counseling. Coverage varies by state. These treatments are often provided under a healthcare professional’s supervision. These services may be covered if they are part of a treatment plan for obesity or a related health condition.

Does Tricare cover weight-loss programs?

Tricare typically doesn’t cover commercial weight-loss programs. But it may cover medically supervised weight-loss treatments. This can include medical nutrition therapy or counseling.

Do VA benefits cover weight-loss programs?

The VA offers a free weight-management program for veterans called MOVE! This program provides classes on nutrition, physical activity, and behavior change. Veterans ages 70 and older or those with a BMI of 25 to 30 are eligible to enroll.

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Written by:

Mitzi S. Morris

Mitzi S. Morris is a freelancer who writes long-form content such as blogs, e-books, and white papers. She has a certificate in digital communication from the University of North Carolina at Chapel Hill and a Bachelor of Arts in Communication from Hanover College.

Edited by:

Charlene Rhinehart, CPA

Charlene Rhinehart, CPA, is a personal finance editor at GoodRx. She has been a certified public accountant for over a decade.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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