General Overview
Medicare is an American healthcare program supported by the federal government. It provides healthcare benefits to people over 65 or to people who meet certain special criteria. It was signed into law in 1965 by President Lyndon B. Johnson. Medicare is partly financed by payroll taxes and partly from the income taxes of United States residents. Medicare consists of four different parts, which cover different types of medical needs. Part A covers hospital insurance, while Part B covers medical insurance. There are also Parts C and D, which cover other needs such as prescription drugs. However, medicare does not provide 100 percent coverage, and the individual must still pay for certain things out of pocket. This does not mean that there are certain procedures that are not covered at all. It just means that a portion of the costs (about 10-20 percent) of all procedures including surgeries or routine check-ups must be paid by the individual. Basically, medicare insurance only covers about 80-90 percent of any procedure's cost.
Medicare and Gastric Bypass Surgery
Coverage of gastric bypass surgery by medicare programs is very limited. According to the Medicare Coverage Manual, there are two cases that account for financial coverage of gastric bypass surgery. Medicare pays for gastric bypass surgery only if it is deemed medically necessary for the individual as determined by his/her personal physician. Medicare also pays for gastric bypass surgery if the surgery is necessary to correct an illness that was either caused or aggravated by a person's obesity.
Other Factors
Medicare does not cover the costs of obesity because under its guidelines, obesity is not considered a true illness. However, treatments for illnesses that are caused or aggravated by a patient being in an obese state, such as type 2 diabetes, are often at least partly covered by Medicare. The program is particularly strict when it comes to paying for obesity related surgeries or treatments.
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