- Are you a Medicare Part B insurance holder?
- Are you considered clinically obese with Body Mass Index of 30 or more?
- Do you know Medicare Part B covers certain weight loss services if provided by a qualified health care provider?
Medicare coverage for weight loss – what is covered and what is not?
Did you know that the 2010 Affordable Care Act (ACA), mandates all health insurances, including Medicare, to provide coverage for screening for obesity for all adults irrespective of their weight?
Obesity screening & counseling coverage by Medicare part B
At that screening visit, if it was found by the patients primary care provider that the patient does have a body mass index (BMI) of 30 or more, then Medicare covers behavioral counseling sessions for obesity.
How often does Medicare cover weight loss related services for the obese?
Medicare covers these IBT sessions for obesity once every week for the first month and once every other week for the next 5 months to help you lose weight. After the initial first 6 months, if the patient has lost at least 3 kilograms of body weight or 6.5 lbs, then coverage for obesity will be extended by another 6 months.
Where can I get the IBT for obesity?
This counseling may be covered if you get it at any physician’s office that is considered a primary care setting, where it can be coordinated with your other care and a personalized prevention plan.
Who’s eligible for Medicare Screening for obesity?
All people with Medicare Part B (Medical Insurance) irrespective of their body mass index for the screening for obesity.
Who’s eligible for Medicare IBT counseling for obesity?
If a Medicare patient has a BMI of 30 or more, IBT for obesity will be covered if provided by a qaulified primary care provider. Since this is a service that all primary doctors provide, it is sufficient that the provider that seek this service meets the definition of primary care provider as defined by Medicare.
Cost of Screening Services for Obesity for Medicare Part B holders
You pay nothing for this screening for obesity as it is considered a preventive service if the primary care doctor or other qualified primary care practitioner accepts Medicare.
Medicare coverage for Intensive Behavior Therapy (IBT) for obesity
What does the Medicare Intensive behavioral therapy(IBT) for obesity consists of the following:
- Screening for all adults for obesity with measurement of Body Mass Index and if found to have a BMI of over 30, do the following:
- Dietary (nutritional) assessment; and
- Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.
What are the 5 A principles of Medicare IBT for obesity?
- Assess: Ask the patient (get the history) as to what is causing the weight gain such as their eating habits, food cravings, behaviors etc.
- Advise: Give clear advice on the risk and benefits of losing weight such as reduced risk of high blood pressure, diabetes, heart disease etc.
- Agree: Identify the goals, and methods to get the goals, enquire about and agree on patient’s interest in and willingness to change the behavior.
- Assist: Using behavior change techniques such as self-help and/or counseling, aid the patient in achieving agreed-upon goals.
- Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
How often does Medicare Cover IBT for obesity?
- One face-to-face visit every week for the first month;
- One face-to-face visit every other week for months 2-6;
- One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement as discussed below.
What happens after 6 months of getting the IBT for obesity?
At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.
What is the minimum amount of weight loss required by Medicare in the first 6 months of receiving IBT for obesity?
To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg over the course of the first six months of intensive therapy as documented in the physician office records for applicable beneficiaries consistent with usual practice.
What happens if I fail to lose at least 3kg of weight in the first 6 months of IBT?
For those that do not achieve a weight loss of at least 3kg during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six month period.
How do you define a primary care setting for the purposes of receiving IBT for obesity?
For the purposes of this decision memorandum, a primary care setting is defined as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Which facilities are excluded from Medicare covered IBT for obesity?
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Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.
Do most W8MD weight loss centers accept Medicare?
Most W8MD physician weight loss centers are not only participating in Medicare Part B but also qualify for the primary care setting definition although exceptions do exist. Please contact the individual W8MD physician weight loss center for further information.
Does Medicare cover diet pills or appetite suppressant prescription medications?
In general, Medicare part D does not provide coverage for diet pills or prescription weight loss medications as these were considered excluded under the Medicare law although this might change in the future.
What are the W8MD’s weight loss centers that provide IBT for obesity and other weight loss services for Medicare patients?
For a list of the latest list of the W8MD weight loss centers, please contact the main website at www.w8md.com