Medicaid for Weight Loss Surgery

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If you lack the financial resources to meet your medical bills, you can check your eligibility for government financial assistance rather than delaying the surgery. Medicaid for bariatric surgery in the United States can be availed from the government, non-profit organizations, and hospitals upon fulfillment of the eligibility criteria.

Usually, individuals desist from getting surgery as they fear not being able to pay the huge medical bills. Due to financial constraint, people end up aggravating their medical problems, such as morbid obesity, which require immediate treatment. To avoid this, they can resort to financial assistance in the form of Medicaid for weight loss surgery.

What is Medicaid?

Medicaid is a joint program of the federal and state governments of the United States that aids payment of healthcare costs of the individuals and families who have limited income and resources.1

Check if you qualify for Medicaid. Click here!

Weight Loss Surgeries Covered by Medicaid

Medicaid covers the following weight loss surgical procedures:

Accessing Medicaid for Bariatric Surgery

Every state in the USA has its own eligibility criteria to be fulfilled for an individual to pursue weight loss surgery. However, what remains common for all the states is that weight loss surgery can be done only if it is a medical requirement, and not as a cosmetic surgery.

For instance, in the state of Colorado, the eligibility criteria for availing Medicaid for weight loss surgery are as follows:

  • BMI of 40 or higher or of 35-40 with at least one additional disease/disorder, such as high blood pressure, diabetes, etc
  • The BMI level qualifying the client for surgery with the co-morbidities must be of at least two years’ duration
  • The individual must have made at least one serious clinically supervised attempt to lose weight (6 months or longer) in the past 18 months before putting in the authorization request, under the supervision of a registered dietitian working in consultation with a physician, nurse practitioner, or physician’s assistant
  • The individual must be committed to losing weight and changing lifestyle permanently post surgery.
  • For individuals below 18 years of age:
    • There should be no diagnosis of genetic or syndromic obesity
    • Girls should have attained Tanner stage IV breast development
    • Should have attained 95% of the estimated adult height1

Qualification of an individual for Medicaid also partly depends on whether the state offers expanded Medicaid program. The Medicaid coverage is as follows:

All U.S. states: Qualification of an individual depends on income, household size, disability, status of the family and other factors. Eligibility criterion varies from state to state.

States offering expanded Medicaid Program: Qualification of an individual is based only on income levels. If the household income is below a certain percentage (usually 133%) of the Federal Poverty line, the person qualifies.2

Click here to check if your state provides for expanded Medicaid program!

How to Go About Medicaid for Bariatric Surgery?

Every state in the U.S. has its own list of eligibility criteria and weight loss procedures.

  • Check the website of your state government
  • Check if Medicaid is granted for your desired procedure
  • See if you qualify for availing Medicaid and how much cost coverage it will give you
If your state does not cover the desired weight loss procedure, you could consider medical tourism. Mexico offers many pocket-friendly, yet quality surgical options. Contact us to know more.

Reasons for Not Qualifying for Medicaid

An individual may not qualify for Medicaid for weight loss surgery if:

  • There has been a long-term steroid use by the person, for medical reasons or otherwise
  • The candidate is suffering from malignant cancer
  • They have inflammatory bowel disease, chronic pancreatitis, pregnancy, or if they have not complied with medical treatment
  • They are undergoing psychological treatment that can affect compliance with post-surgery diet and lifestyle changes2
In the fiscal year 2016, California was the leading state in Medicaid spending followed by New York and Texas.3

Advantages of Medicaid

  • Financial benefits, as the surgery is government-aided and minimal out-of-pocket expenditure is incurred
  • No burden of debt or interest payment
  • Reduction in the overall medical bills of the individual
  • Better financial health of the low-income households
Medicaid covers one in every five Americans and a total 74 million people.4

Limitations of Medicaid

Rigid Eligibility Criteria: Stringency in the eligibility criteria makes it difficult for individuals to access Medicaid. At times, people do not qualify but are in dire need for surgery.

Limited Cost Coverage: Medicaid covers a specific portion of the total cost of the surgery and the rest has to be borne by the individual.

Limited Scope: Not every weight loss surgery is included in the Medicaid program.

Not All Doctors Accept Medicaid: Due to limited reimbursement rates, many doctors abstain from taking on MedicaidIn 2015, only 67% of doctors accepted Medicaid and only 45% of doctors took new patients on Medicaid.5

It doesn’t support Medical Tourism: Financial assistance via Medicaid for weight loss surgery is limited to treatment within the United States only. This limits the treatment options, especially the ones available abroad.

Weight loss surgery in Mexico is a great option since it is very cheap as compared to the surgery costs in U.S. It also offers the advantage of internationally trained doctors who have achieved expertise in weight loss surgeries. But sadly, Medicaid won’t help you in this regard.

It is projected by the Congressional Budget Office that by 2026, Medicaid would cover 14 million less people than it covers presently.4

Difference between Medicaid and Medicare

Medicare and Medicaid are often considered one and the same thing but they are not. Medicare is healthcare insurance program launched specifically for individuals above the age of 65 unlike Medicaid, which can be availed by all age groups.

Check out the following table for a better understanding:

MedicareMedicaid
It is a federal health insurance program for individuals:

  1. Above the age of 65 years
  2. Below 65 years with specific disabilities

Of any age with End-Stage Renal Disease or Lou Gehrig’s disease.

It is a joint health program of the federal and state governments that aims to provide financial assistance for healthcare costs of people with limited income.
It is governed by federal government.It is governed by the state government.
Majority of the people are enrolled in it automatically when they turn 65.Eligibility depends on the state where you stay.

Medicaid for bariatric surgery is a great option for people in the United States with low income. By fulfilling the eligibility criteria, the financial assistance for weight loss surgery can be easily accessed. However, this financial option has its own limitations and if an individual chooses to avail it, the same should be done after a careful analysis of all the aspects of the surgery, such as price, reputation, and experience of doctor.

For more information and a free quote, contact us now!

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