Medicare covers lap band (laparoscopic banding) surgery if you meet the criteria. Your out-of-pocket costs can depend on the specific coverage you have and the services you need.
Medicare generally covers lap band surgery, or laparoscopic banding surgery, for people with obesity who meet all the requirements.
But you may have out-of-pocket costs associated with the procedure. These costs may vary depending on:
- where your procedure is performed, whether at a hospital or outpatient facility
- your specific coverage, whether Original Medicare (parts A and B) or a Medicare Advantage (Part C) plan
- whether you have supplemental coverage, such as a Medigap plan
Keep reading to learn about the eligibility, coverage, and costs of lap band surgery if you have Medicare.
if you meet all of the requirements, Medicare covers bariatric surgery, including lap band surgery and gastric bypass surgery. The requirements include:
- having a body mass index (BMI) of 35 or higher
- having at least one additional health condition related to obesity
- having previously had other medical treatments for obesity that did not work
If you meet these requirements, both Original Medicare and Medicare Advantage plans will cover the cost of the surgery, as well as any services relating to the surgery.
These costs can include:
- medical appointments relating to the surgery
- testing (including lab tests) before and after the procedure, as needed
- your hospital stay, if you receive the surgery in a hospital
- any medications or durable medical devices you need during recovery
If you meet the requirements, Medicare typically covers most of the costs relating to lap band surgery. Your exact out-of-pocket costs for lap band surgery with Medicare can depend on the specific services you need.
For example, some people need to lose a certain amount of weight prior to surgery or may require a longer hospital stay. Your doctor and surgery team can give you an idea of the services they anticipate you needing before, after, and during surgery.
In general, you can expect to pay the standard out-of-pocket costs. In 2024, these can include:
- Part A deductible: You pay a deductible of $1,632 each time you are admitted to the hospital.
- Part A coinsurance: If you stay in the hospital for more than 60 days but fewer than 90 days, you will have to pay additional coinsurance costs of $408 per day.
- Part B deductible: You pay a Part B deductible of $240 per year when using Part B coverage.
- Part B coinsurance: After paying your deductible, you pay a Part B coinsurance cost of 20% of each service.
- Part D (drug coverage) deductible: If you require prescription medications, you will pay the cost of your Medicare Part D deductible. This cost varies by plan.
If you have additional coverage through a Medigap plan, the plan may cover some of these costs.
A Medicare Advantage plan may also cover additional services associated with lap band surgery or weight.
You may also qualify for financial assistance programs that help cover these out-of-pocket costs.
How long does it take Medicare to approve weight loss surgery?
While there is no set approval time frame for approving weight loss surgery, Medicare requires that you try nonsurgical medical treatment for weight loss before you can qualify for weight loss surgery.
Medicare approves weight loss surgery only if another medical treatment for weight loss has not worked. If you have not yet tried medical treatment for weight loss, you may need to try it for a few months before Medicare will approve surgery.
How do you qualify for a gastric lap band?
Medicare approves bariatric surgery, including lap band surgery, if you meet the requirements of having a BMI of 35 or over, having one medical condition caused by obesity, and having tried another medical treatment for weight loss that wasn’t effective.
Is 65 too old for lap band surgery?
Bariatric surgery can benefit older adults, according to a
Medicare covers lap band surgery and other types of bariatric surgery if you meet all of the requirements.
You still have to pay out-of-pocket costs, including coinsurance and copays. Medigap plans or assistance programs may help cover some of these costs.
Read more about Medicare and weight loss program coverage.
