Medicare Coverage for Diet, Exercise, & Weight Loss

Medicare Coverage for Diet, Exercise, & Weight Loss

Staying committed to healthy eating and regular physical fitness is even more important as we age. As we get older, we are faced with changes we can’t avoid. Loss of muscle tissue, bone density, and joint flexibility can contribute to long-term health conditions, such as osteoporosis, injuries due to falls, reduction in mobility, and osteoarthritis, just to name a few. Seniors are more susceptible to malnutrition due to a slower metabolism, medications that prevent nutrient absorption, and a decrease in the body’s ability to synthesize Vitamin D and absorb and retain calcium.

Many seniors face weight problems due to a reduction in daily activity and poor nutrition as they get older. Weight gain and obesity can put you at higher risk for heart disease, stroke, diabetes, and other life-threatening diseases. With regular exercise and the right diet, we can prevent many of these problems – and Medicare can help!

Medicare is health insurance for individuals over the age of 65 (or under 65 due to certain disabilities), and many of its benefits can help you prevent illness and injury caused by poor nutrition or exercise as we age.  Whether you are new to Medicare and want to get a fresh perspective on your health, need help recovering from a serious illness that has affected your diet and exercise, or want to discuss obesity screenings and counseling and weight loss procedures covered by insurance, you have access to a number of Medicare benefits that can get you the help you need to get healthy.

Here are just a few Medicare benefits that may help you address diet, exercise, and weight loss issues:

Welcome to Medicare Visit

The Welcome to Medicare preventive visit takes place within your first 12 months with Medicare Part B. This introductory visit will help you establish a rapport with your physician, and allow you to go over important information, including, but not limited to:

  • Height, weight, and blood pressure measurements
  • Calculation of your body mass index (BMI)
  • Certain screenings, shots, or referrals to other care 

If you’ve noticed a change in your weight and are meeting a new doctor, let them know about the changes you’ve noticed. You can work together to figure out if the weight gain is merely the symptom of an underlying problem, or if you need to consider changes to your diet and physical fitness. You can also discuss weight loss procedures covered by insurance if the results of your exam indicate a need.

Yearly Wellness Visit 

If you’ve had Part B for more than 12 months, Medicare will cover this visit, as long as 11 full months have passed since your last visit. The Yearly Wellness Visit gives you the opportunity to stay on track with health goals and includes routine measurements, an update on medications you’ve been taking, and an overall review of your health history. Visiting the same physician each year can be very beneficial. Your physician will be able to review past measurements and vitals, and can address any concerns they may have about your weight or health.

Obesity Screening & Counseling

If your doctor evaluates your body mass index (BMI) and determines that your BMI is 30 or higher, Medicare Part B will cover behavioral therapy sessions to help you lose weight. This counseling may be covered if you get it in a primary care setting, such as a physician’s office, where it can be coordinated with your other care. Your physician can help you create a personalized plan to improve your health with diet and exercise.

Nutrition Therapy 

Many seniors are considered malnourished due to changes in their habits, but certain diseases and chronic conditions can have an impact on your nutrition and weight. Medicare helps cover some medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months. Medicare Part B (Medical Insurance) covers medical nutrition therapy (MNT) and some specific related services. A Registered Dietitian or nutrition professional who meets certain requirements can provide these services, but only your doctor can refer you for these services. 

Medical Nutrition Services may include:

  • An initial nutrition and lifestyle assessment
  • One-on-one nutritional counseling
  • Follow-up visits to check on your progress in managing your diet

If you live in a rural area, a Registered Dietitian or other nutritional professional in a different location may be able to provide MNT to you. If you get dialysis in a dialysis facility, Medicare covers MNT as part of your overall dialysis care.

Cardiac Care - Nutrition & Exercise Programs

Medicare Part B covers cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) programs that include exercise, education, and counseling if you have had at least one of these conditions:

  • A heart attack in the last 12 months
  • Coronary artery bypass surgery
  • Current stable angina pectoris (chest pain)
  • A heart valve repair or replacement
  • A coronary angioplasty (a medical procedure used to open a blocked artery) or coronary stenting (a procedure used to keep an artery open)
  • A heart or heart-lung transplant
  • Stable chronic heart failure

Weight Loss Procedures & Surgery

Does Medicare cover weight loss surgery? According to the Centers for Medicare & Medicaid Services (CMS), Medicare covers some bariatric surgical procedures under certain circumstances, such as: 

  • Gastric Bypass - Makes the stomach smaller and reroutes the intestines
  • Adjustable Gastric Banding - Less invasive procedure places an implant around the top of the stomach
  • Sleeve Gastrectomy - A two-stage surgery reducing the size of the stomach and a year later, bypassing the intestines to reduce calorie consumption
  • Vertical Gastric Banding – Known as “stomach stapling”

Medicare will help cover the cost of some weight loss surgeries based on conditions related to morbid obesity. Morbid obesity is defined as having a BMI of 35 or more, accompanied by an obesity-related condition, like high blood pressure or diabetes. Discuss the weight loss procedures covered by Medicare insurance with your physician.

Medicare Advantage & SilverSneakers

If you are enrolled in a Medicare Advantage (MA) plan, you have the same Part A and Part B benefits covered by Original Medicare, but many MA plans offer additional benefits. Many MA plans have partnered with SilverSneakers, a fitness program designed specifically to provide seniors with free access to local fitness centers. Check with your Medicare Advantage plan to find out if you are eligible to take advantage of the incredible opportunity and start enjoying unlimited access to weights, fitness classes, treadmills, and pools in over 14,000 locations across the country.

Medicare preventive services can have an important impact on your well-being by providing the help you need to stay - or get - healthy. Don’t underestimate the importance of annual visits with your physician to discuss changes in your health and any challenges you may be facing. Your physician can help you find the right solutions to your nutrition and fitness needs, and your Medicare benefits can help cover some of the costs of counseling, therapy, weight loss procedures, and issues related to obesity, including obesity screening and counseling. Talk to your doctor today to explore ways Medicare can help you stay healthy and fit.