Does Medicare Cover Weight Loss Surgery? Bariatric Coverage Explained

Which weight loss surgeries does Medicare cover?

Medicare has a national rule (a National Coverage Determination) that spells out which bariatric procedures are covered for beneficiaries who meet the clinical criteria. If you qualify, Medicare covers these surgeries nationwide:

• Roux-en-Y gastric bypass (RYGB) - open and laparoscopic
• Biliopancreatic diversion with duodenal switch (BPD/DS) - open and laparoscopic
• Laparoscopic adjustable gastric banding (LAGB), often called a gastric band
• Laparoscopic sleeve gastrectomy (the gastric sleeve) is NOT covered nationally, but since June 27, 2012 your local Medicare Administrative Contractor may choose to cover it for beneficiaries who meet the same criteria.

Eligibility: BMI, co-morbidities, and prior treatment

To have any of these surgeries covered, Medicare requires you to meet all three of the following conditions:

• A body-mass index (BMI) of 35 or greater.
• At least one obesity-related co-morbidity, such as type 2 diabetes, cardiovascular (heart) disease, or COPD.
• A history of being previously unsuccessful with medical (non-surgical) treatment for obesity - in other words, you tried other approaches first and they did not work.

Facility rules and required evaluations

Meeting the BMI and health requirements is the core of coverage, but documentation matters too.

Important update: Original Medicare USED to require that bariatric surgery be performed at a certified or accredited 'Center of Excellence.' CMS removed that facility-certification requirement effective September 24, 2013, so Original Medicare no longer requires an accredited or certified facility for a covered procedure. (A Medicare Advantage plan, however, may still require you to use an in-network facility - see the Medicare Advantage section below.)

CMS guidance does call for a multidisciplinary evaluation in the preoperative period to confirm that surgery is medically appropriate. That evaluation typically includes:

• A bariatric surgeon's recommendation for the procedure.
• A separate medical clearance from a physician other than the surgeon (often your primary care doctor).
• A mental health / psychosocial clearance.
• A nutritional evaluation by a physician or registered dietitian.
• These evaluations help confirm that surgery is medically appropriate and that you are prepared for the lifestyle changes that follow.

What will you pay out of pocket in 2026?

Bariatric surgery is generally an inpatient hospital procedure, so it falls mostly under Medicare Part A, with the surgeon and other physician services billed under Part B. Here is how the 2026 cost-sharing works.

Part A (hospital) costs per benefit period in 2026: a deductible of $1,736, then $0 coinsurance for days 1-60, $434 per day for days 61-90, and $868 per day for lifetime reserve days. Most bariatric stays are short, so many beneficiaries pay only the deductible.

Part B (physician/outpatient) costs in 2026: an annual deductible of $283, then 20% coinsurance of the Medicare-approved amount for the surgeon and other doctor services. You must be enrolled in Part B to get coverage for those services; the standard Part B premium is $202.90 per month in 2026.

One thing Medicare does not pay for: transportation costs to get to the bariatric surgery center.

Medicare Advantage and Medigap

How you pay can change a lot depending on the kind of Medicare coverage you have.

A Medicare Supplement (Medigap) plan can cover the Part A deductible and the Part B 20% coinsurance you would otherwise owe for bariatric surgery, which can sharply reduce your out-of-pocket cost. Benefits vary by Medigap plan letter, so check your specific plan.

A Medicare Advantage plan must cover at least the same surgeries that Original Medicare covers, but the plan may apply its own cost-sharing, require prior authorization, and require you to use an in-network certified facility. Coverage rules vary by plan - confirm the details in your plan's Evidence of Coverage and ask about prior authorization before scheduling surgery.

Counseling, weight loss drugs, and what isn't covered

Surgery is not the only weight-related benefit, and some treatments are specifically excluded.

Obesity behavioral therapy: Medicare covers intensive behavioral counseling on diet and exercise for beneficiaries with a BMI of 30 or higher when it is furnished by a qualified primary care practitioner in a primary care setting. The schedule is one face-to-face visit per week in month 1, one every other week in months 2-6, and one per month in months 7-12 (the months 7-12 visits require that you lost at least 3 kg in the first 6 months). Because this is a preventive service, you pay nothing - no coinsurance and no deductible - if your provider accepts assignment.

Weight loss drugs (including GLP-1 medications): By law, prescription anti-obesity drugs are excluded from Part D when used for weight loss. They can be covered under Part D only when used for another medically accepted indication, such as type 2 diabetes or to reduce cardiovascular risk in adults with established heart disease and obesity or overweight. Separately, CMS is running a short-term demonstration called the Medicare GLP-1 Bridge that gives eligible Part D beneficiaries access to certain GLP-1 drugs - all formulations of Wegovy, all formulations of Foundayo, and the KwikPen formulation of Zepbound - for $50 for a monthly supply between July 1, 2026 and December 31, 2027.

• Gastric balloon for the treatment of obesity is non-covered for all Medicare beneficiaries.
• Supplemented fasting is not a covered surgical treatment of obesity.
• Transportation to the surgery center is not covered.