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How Does Medicare Obesity Therapy Work?

Medicare Bob
Medicare General Info
For people looking to lose weight, Medicare’s obesity behavioral therapy and counseling program may help.
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If you’ve been advised by a doctor to lose weight for health reasons or you’ve decided to embark on your own weight-loss journey, Medicare obesity behavioral therapy can help you get started. This type of counseling is different from the garden-variety weight-loss programs out there. Officially known as intensive behavioral therapy for obesity, this Medicare program was created to address the significant and chronic health issues that stem from carrying an excessive amount of weight.

According to the Centers for Disease Control and Prevention (CDC), 42% of Americans ages 20 and older fall in the obese range. The goal of Medicare obesity therapy is to help people detect early signs of disease or disability related to their weight. Let’s find out exactly what Medicare obesity behavioral therapy entails and whether you qualify.

How Your Body Mass Index Helps You Qualify

Medicare may cover obesity counseling, but first, you must qualify for the program. To start, your body mass index (BMI) must be 30 or higher. This is a measurement of your weight relative to your height and can indicate the amount of fat you are carrying. (To find your number, try this BMI calculator.) You will also need to be assessed by a medical practitioner to qualify.

If your BMI falls in the qualifying range, Medicare Part B may cover obesity screenings and behavioral therapy to help you improve your diet and exercise routine. It may also cover nutrition therapy services if you have diabetes or kidney disease or if you have received a kidney transplant in the last 36 months.

Medicare can only cover obesity counseling if your primary care doctor or other qualified practitioner provides it in their primary care setting. Enrolled participants of Part B who qualify won’t pay a deductible or copay for this intensive obesity counseling because it’s one of the preventative services covered in full by the Affordable Care Act.

It is possible, however, that your doctor may recommend additional services or more counseling than Medicare covers. Those services may need to be paid out of pocket.

What Does Medicare Obesity Counseling Entail?

Medicare counseling for obesity may be covered for a maximum of 22 sessions over 12 months, with a breakdown that looks like the following:

  • First month: one session per week

  • Months 2-6: one session every other week

  • Months 7-12: one session per month if you’ve lost 6.6 pounds (3 kilograms) or more by the time you reach your sixth month of counseling

The sessions include the initial BMI assessment, a nutrition evaluation and ongoing counseling on dietary and exercise programs. At six months, you’ll go through an assessment to see if you’ve met the required weight-loss benchmark to continue counseling. If you have lost 6.6 pounds or more, you can receive another six months of free counseling. If you miss the weight-loss target, you must wait six months for reassessment.

Know What Original Medicare Doesn’t Cover

If you carry Medicare Advantage (Part C) coverage, some additional services may be covered or partially covered through your plan. That could include:

In addition to weight-loss consults with specialists, Medicare may not cover anti-obesity medications, weight-loss meal delivery or access to programs, such as Weight Watchers. (But it may cover bariatric surgery if your doctor deems it necessary.)

If you need help understanding your options, call 1-833-463-3262, TTY 711 to speak with a licensed agent at Senior Healthcare Direct.

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 LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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