Which Weight Loss Drugs Are Covered by Medicare?
Weight loss Drugs can help those fighting obesity and other health issues associated with increased weight. Yet, the cost of such drugs can be quite high and may be out of reach for many. Considering people on Medicare, understanding weight loss drugs prescribed will tell which ones are covered by their insurance plan is important. Let us delve into how Medicare treats these drugs and other aspects necessary to take informed decisions about one’s health.
Coverage of Drugs in General by Medicare
Medicare is a federal social insurance program primarily intended for individuals aged 65 and above or those who qualify under specified disabilities. To that end, Medicare provides extensive coverage for many health-related treatments; however, issues of administering weight loss drugs often put Medicare into a gray area.
Generally speaking, these medications are prescription medications whose administration is under the scope of treatment for illnesses. Since the administration of weight-loss medications has usually been considered lifestyle-associated and not necessarily life-saving, some claim Medicare should essentially not allow its use as an exception for people with a legitimate condition not deemed necessary for ready reimbursement; however, Medicare does seem to call for prescription coverage for weight-loss medications in some cases.
Medicare and Weight Loss Drugs: An Overview
Part D of Medicare is basically the one covering prescriptions.
1. Administration
– Most stand-alone Part D plans and most Medicare Advantage plans (Part C with drug coverage) prefer not to have any attendance to weight-loss drugs. This is due to compliance by the Centers for Medicare & Medicaid Services (CMS), which does not develop the deficiencies required of Part D plans administering medications to be considered cosmetic or lifestyle esthetic medical preparations.
– Exceptions do apply if a diet pill is prescribed in treatment for an underlying medical condition, such as high blood pressure or diabetes associated with obesity.
What You Need to Undertake
1. To find if your particular Medicare Part D plan covers weight loss medications, review your plan formulary.
2. Discuss with your doctor whether a weight loss drug is medically necessary due to your condition.
3. If you believe coverage should apply, reach out to your insurer for the prior authorization or appeal processes.
Medicare Will Possibly Cover for Weight Loss Treatments
Medicare has coverage for some weight-loss interventions, although it does not generally cover the treatment when deemed a weight-loss drug.
1. Obesity Screening and Counseling (Part B) – Obamacare Part B covers these as screening and therapeutic counseling for persons whose BMI stands at the threshold of 30 or above. Here, the sessions would be meant to promote a change of lifestyle to assist diet control.
2. Bariatric Surgery – Medicare covers surgery on such extreme obesity cases along with health problems comorbid to it. These procedure types include gastric bypass or sleeve surgery and others.” Generally, surgery may be utilized when all other alternative weight loss techniques have failed.
3. Nutritional Counseling – Nutrition can be covered under your plan if you have been diagnosed with diabetes or chronic kidney disease, although this is not so much aimed at weight loss.
Alternative Options for Weight Loss Drug Not Covered by Medicare
You do not have to give up on maintaining weight if you find that Medicare would not cover weight loss formulary drugs.
1. Lifestyle Changes
2. A Balanced Diet and Regular Exercise – The greatest two of the listed activities absolutely need to be true for successful lifelong weight maintenance.
3. Discuss possible general programs such as Weight Watchers or community wellness groups for support.
2. Over-the-Counter Medications
-Inquire with your doctor whether over-the-counter options would include Orlistat (Alli) and if they have any chances of aiding you.
3. Generic Medication
– There are over-the-counter medicines that are cheaper among some weight loss drugs.
4. Public subsidies for medication assistance programs
Explore local programs that help people access various life-saving weight loss medications or health services at reduced or little cost.
Conclusion
Medicare’s offerings regarding the provision of weight-loss drug coverage are scant and beneficiaries of the services should not look forward to any form of routine inclusion of anti-obesity medications in their plan of care. However, one area that Medicare does offer support on is one of imparting behavioral counseling, nutritional counseling, and willing prospects towards surgery. If you’ve been considering weight-loss drugs, make an appointment to discuss it with your health care provider–and take a close look through your Medicare plan options as well and see just what’s covered and what else is available if not.
Achieving and maintaining a healthy weight is indeed a lifelong journey, and even without Medicare coverage for weight-loss drugs, numerous tools and techniques abound to help you out in your quest.
