Medicare & Medicaid

Overview of Medicare

Lap-Band Financial HelpMedicare is a federally funded health insurance program that is available to people age 65 or older or for people under 65 with qualifying disabilities. Morbid obesity is one of the qualifying disabilities under the Social Security Act. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). To determine if you qualify for Medicare coverage or want additional information, contact the local social services agency in your area or check out the website for either the CMS (www.cms.gov) or the HHS (www.hhs.gov).

Overview of Medicaid

Medicaid is a federally funded health insurance program that provides health care and related health-services to qualifying low-income people. The Medicaid program is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the United States Department of Health and Human Services (HHS). Medicaid eligibility is based on income and other factors such as age, disabilities, citizenship, and other resources. If you want more information or want to see if you qualify for Medicaid, contact the local social services agency in your area or check out the website for either the CMS (www.cms.gov) or the HHS (www.hhs.gov). Medicaid coverage for lap band surgery is decided on a state by state basis.

Medicare Coverage for Lap Band Surgery

Medicare will cover lap band surgery for qualified patients when the procedure is performed by approved surgeons and facilities. Medicare coverage and requirements went into effect on February 15, 2006. Like many insurance programs, Medicare patients may have a co-payment amount even if they qualify. Although Medicare pays for weight loss surgery, they do not pre-authorize so it is important to be certain of the requirements for surgery coverage.

Medicare qualified patients are Medicare beneficiaries who have a BMI (body mass index) greater than 35, have at least one co-morbidity related to obesity, have been unsuccessful in losing weight with previous medical treatments for obesity, and lap band surgery is considered a medical necessity. Approval for weight loss surgery is not automatic, but reviewed on a patient by patient basis.

Lap Band Surgery

Medicare approved surgeons and facilities will either be certified as a Level 1 Bariatric Surgery Center by the ACS (American College of Surgeons) or be designated as a Center of Excellence by the ASMBS (American Society for Metabolic & Bariatric Surgery). These approvals indicate that certain criteria and standards have been met to ensure patient safety.

Medicare Providers for Lap Band Surgery

Not all physicians are Medicare providers. If you need help finding a Medicare provider for bariatric surgery, you can visit the website for The Centers for Medicare & Medicaid Services and search the directory listing of Medicare approved facilities for bariatric surgery.

Go to the website at (www.hhs.gov), first choose the More section under Medicare, second choose Medicare approved facilities under Medicare general information, third choose bariatric surgery from the overview column on the left hand side of the screen. This should bring up a list of all approved facilities in the US.

The website for the ASMBS (American Society for Metabolic & Bariatric Surgery) also offers a search feature for bariatric surgeons and Centers of Excellence that are ASMBS members.

Go to the website at www.asmbs.org and first go to the link for patients and then choose member search.

Apply to Medicare & Medicaid for Lap Band Surgery

Low income patients may qualify for the Medicare or Medicaid programs offered by the Department of Health and Human Services. If you want more information or want to find out if you qualify for Medicare or Medicaid, contact your local social services agency in your area or check out the website for either the CMS (www.cms.gov) or the HHS (www.hhs.gov).

If you are already covered by Medicare or Medicaid, you will need to find a bariatric surgeon that accepts this form of insurance. If they accept this form of insurance, they will be familiar with the process and can help you with the necessary information as applies to your particular case.