Body mass index (BMI) is a measure of body fat in adults. BMI screenings and follow-up behavioral counseling can help you lose weight if your BMI is high.
Eligibility
Medicare Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. covers BMI screenings and behavioral counseling to help you lose weight if you are obese. You are obese if you have a BMI of 30 or higher.
Once your doctor diagnoses you as obese, you can qualify for behavioral counseling and therapy to help you lose weight and sustain weight loss through proper diet and exercise. Medicare covers a series of visits for behavioral counseling:
- One face-to-face visit every week for the first month
- One face-to-face visit every other week during months 2-6
- One face-to-face visit every month during months 7-12 if you lose 6.6 lbs within the first six months*
*After your first six months of therapy, you will be re-screened for obesity. During this re-screening, your doctor will determine how much weight you have lost since your initial screening. To be eligible for additional face-to-face visits with your doctor during months 7-12 of behavioral therapy, you must lose at least 6.6 lbs (3 kg) during the first six months of therapy. If you do not lose at least 6.6 lbs during the first six months of behavioral visits, your therapy may end. Your doctor can reassess you for another Medicare-covered obesity screening after six months have passed.
Costs
If you qualify, Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. covers BMI screenings and behavioral counseling at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plans are required to cover BMI screenings without applying deductibles, copayments, or coinsurance when you see an in-network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. provider and meet Medicare’s eligibility requirements for the service.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.