What you need to know about bariatric surgery
Medicare may cover bariatric surgery when it’s medically necessary and eligibility requirements are met. Coverage depends on the procedure and whether you have Original Medicare or a Medicare Advantage plan.
What is bariatric surgery?
Bariatric surgery is a type of weight loss surgery. It may be used alongside or instead of weight loss drugs like GLP-1s. There are several different kinds, including gastric bypass (reroutes digestion), lap-band surgery (adds an adjustable stomach band) and gastric sleeve surgery (shrinks the stomach). They are usually either malabsorptive (meaning the surgery limits calorie intake) or restrictive (meaning it shrinks stomach size). All are used to treat people who are overweight or suffering from related conditions.
These related conditions are often what decide whether the surgery is medically necessary. Diabetes and heart disease are two examples. If you have one of these conditions, a bariatric surgery may be covered by Medicare. Cosmetic surgery is not covered. This means that if the surgery is being used only to improve physical appearance, you are likely not covered.
Does Original Medicare (Part A and B) cover bariatric surgery?
Original Medicare may cover bariatric surgery if it’s medically necessary. All of the following conditions must be met:
- You have a serious, related condition like diabetes.
- You have a body-mass index (BMI) of at least 35.
- You have tried medical treatment for obesity, and it hasn’t worked.
In addition to being medically necessary, the surgery needs to be done at a Medicare-approved place. You can find providers using Medicare’s provider search tool. The operation itself also needs to be approved by Medicare. Gastric bypasses, lap band surgeries and gastric sleeve surgeries are all accepted.
Medicare Part A coverage may help with costs if you have an inpatient hospital stay during the process. Medicare Part B coverage may help pay for outpatient services like doctor visits. Part B may even help cover the surgery itself if you have it done in an outpatient place like a hospital’s outpatient department.
Do Medicare Advantage (Part C) plans cover bariatric surgery?
Medicare Part C coverage offers all the support for weight loss procedures that Original Medicare does. But it often includes added benefits and may work slightly different. For example, some plans may have different costs for you and use different provider networks. You may also need prior authorization. That means your insurance company needs to approve the surgery before you have it done. This may all vary depending on your specific plan. Make sure you check your plan’s details before moving forward with treatment.
Not a member? Explore Medicare Advantage plans
What bariatric surgeries does Medicare not cover?
Medicare doesn’t always cover bariatric surgeries. Here are some conditions where Medicare will not cover them:
- The surgery uses experimental procedures or is not approved for some other reason.
- You are getting the surgery for a nonmedical reason (such as improving physical looks).
- You don’t meet the requirements (BMI, health condition, already tried approved nonsurgical weight loss).
Are you an Aetna® member looking for a bariatric surgeon? Find Aetna Medicare providers
Not a member? Find a Medicare plan that’s right for you
What is the cost of bariatric surgery with Medicare coverage?
Costs can vary widely for surgeries. You won’t know the exact care you’ll need until you meet with your provider. But you can likely expect a few specific cost factors. With Original Medicare, your costs may include:
- The Part A deductible ($1,736 in 2026)
- The Part B deductible ($283 in 2026)
- Out-of-pocket costs
Medicare deductibles are the amount you need to pay before your insurance starts paying. Your out-of-pocket costs are the amount you pay after your insurance has paid its share. These costs vary depending on the type of place you have the surgery and the type of surgery you have.
With Medicare Advantage, your costs may be different depending on your specific plan. Make sure you review your plan details first.
Looking for a Medicare Advantage plan to better support bariatric surgery? Find plans in your area
