Does Medicare and Medicaid cover Bariatric Surgery and Weight Loss Medications?
Yes, Medicare and Medicaid can cover Weight Loss care and Bariatric Surgery. At Tampa Weight Loss Institute we accept both Medicare and Medicaid for Bariatric Procedures and Weight Loss Medications with comorbidities. The next question is almost always: How much do they cover, and what will you pay out of pocket?
What is covered by Medicaid and Medicare
People hear “it’s covered” and assume everything is paid for. In reality, coverage usually has two layers:
- Benefits: Your plan includes Bariatric Surgery as a covered service.
- Approval: You meet the plan’s criteria and your Prior Authorization is approved.
Coverage varies, but many plans commonly consider these parts of care (when medically necessary and properly authorized):
At Tampa Weight Loss Institute, we accept Medicare and Medicaid, and we also work with many Commercial Plans. We verify benefits up front and guide you through the checklist.
Medicare vs Medicaid by State: What’s Different
The key difference is who runs the program:
- Medicare is a Federal program. Baseline eligibility and national coverage rules apply nationwide.
- Medicaid is State-administered under Federal requirements. All States, Washington D.C., and U.S. Territories have Medicaid programs, but coverage details vary by State.
Because Medicaid varies, this guide uses Florida-friendly examples where helpful. If you’re outside Florida, your plan may require a different checklist.
What options do you have with Medicaid?
Medicaid is administered by each State under Federal requirements. That means benefits, approvals, and covered services can look different depending on where you live and which Medicaid plan you’re enrolled in.
What Medicaid coverage commonly includes
- Bariatric Surgery and related services may be covered when medical necessity and plan criteria are met (rules vary by State and plan).
- Prior Authorization is common for Bariatric Surgery and obesity-related services in many Medicaid Managed Care plans.
- Follow-up care, nutritional counseling, and required evaluations are often part of the pre-op process.
- Revision or Conversion Bariatric procedures may be covered in specific situations such as complications, based on State policy and plan rules.
Eligibility Criteria for Medicaid
Bariatric Surgery (Medical Criteria)
Medicaid is State-Run, but the Medical Criteria most commonly used look like:
BMI ≥ 40, or
BMI ≥ 35 with at least one Obesity-Related Comorbidity
Medical Necessity (Obesity creates significant Health Risk)
Many State Medicaid policies use these thresholds in their Obesity Treatment Coverage criteria.
Weight Loss Medications (Medical Criteria)
Two separate Medicaid “Medication” realities exist:
A) GLP-1 Drugs for Diabetes (Commonly Covered)
If the Drug is prescribed for an FDA-Approved indication like Type 2 Diabetes, Medicaid Coverage is far more common (State Programs may still apply utilization rules).
B) GLP-1 Drugs specifically for Weight Management (Varies by State)
Medicaid Programs are not required to Cover Weight Loss Drugs, and many States limit this Coverage.
In States that do Cover Weight-Management GLP-1s, Medical Eligibility Criteria commonly follow FDA-style thresholds such as:
Baseline BMI ≥ 30, or
BMI ≥ 27 with a Weight-Related Comorbidity
Also Worth Noting (Policy Trend): CMS has recently signaled interest in expanding GLP-1 access through voluntary Models for Medicaid and Medicare Part D starting in 2026–2027, but that’s separate from what is reliably Covered today.
Florida Medicaid
Florida Medicaid coverage policy for Gastrointestinal Services explicitly references Bariatric Surgery revisions, reversals, or conversions for complications related to the surgery. In practice, approvals still depend on documentation and the plan’s authorization process.
Florida Medicaid policy documents list Weight Control Medications as non-covered under Prescribed Drug Services, and Florida State Plan materials also describe exclusions for anorectics when used for obesity. If your medication is prescribed for another medically accepted indication, the coverage outcome can differ.
Tampa Weight Loss Institute and Medicaid
Tampa Weight Loss Institute accepts Medicaid and helps patients verify benefits, identify required documentation, and navigate Prior Authorization. This matters because missing one document can turn a simple approval into weeks of delays.
What Options Do You Have With Medicare?
Medicare coverage is based on Federal rules, but your exact experience depends on whether you have Original Medicare or a Medicare Advantage plan. Medicare’s coverage for Bariatric Surgery is tied to specific covered procedures, eligibility requirements, and where the surgery is performed.
What Medicare Coverage Commonly Includes
- Covered Bariatric Surgery procedures (when criteria are met) under Medicare’s National Coverage Determination (NCD).
- Obesity Behavioral Therapy (IBT) in a Primary Care setting for eligible patients.
- Standard pre-op evaluations and follow-up care, when medically necessary and properly billed within plan rules.
Eligibility Criteria
Bariatric Surgery (Medical Criteria)
Medicare Covers certain Bariatric Surgery when all of these are true:
Body Mass Index (BMI) > 35
At least one Obesity-Related Comorbidity (for example: Type 2 Diabetes, Hypertension, Obstructive Sleep Apnea, etc.)
Previously unsuccessful with Medical Treatment of Obesity (non-surgical management)
Weight Loss Medications (Medical Criteria)
For Weight Loss Only (Obesity Treatment):
In general, Medicare Part D does not cover Drugs when used for Weight Loss, because “Agents when used for … Weight Loss” are a Statutory Exclusion under Social Security Act rules tied to Part D.
When the same Drugs are used for a different FDA-Approved Indication (Coverage Possible):
Medicare Part D can cover certain GLP-1 Medications when prescribed for a Covered, Medically Accepted Indication (not “Weight Loss” as the primary indication), such as:
Type 2 Diabetes (example GLP-1 Products approved for Diabetes)
Cardiovascular Risk Reduction: After Wegovy gained an FDA-Approved Cardiovascular Indication, Medicare Coverage becomes possible for beneficiaries with:
Established Cardiovascular Disease (example: prior Heart Attack, Stroke, or Peripheral Arterial Disease) and
Overweight or Obesity
Important Reality Check: even when Coverage is legally allowed for an Indication (like Diabetes or Cardiovascular Disease), Part D Formularies still vary.
Tampa Weight Loss Institute and Medicare
Tampa Weight Loss Institute accepts Medicare and helps patients confirm eligibility, understand covered options, and estimate potential out-of-pocket costs before starting the workup.
Types of Covered Surgeries and Programs
Bariatric Surgery Types
Examples referenced in Medicare’s coverage rules include:
Non-Surgical Weight Loss Programs
Other Insurances
We Work With
Frequently Asked Questions
Does Bariatric Surgery coverage include Revision Surgery?
How long does it take to get approved for Bariatric Surgery by Medicaid?
How long does it take to get approved for Bariatric Surgery by Medicare?
Which States does Medicare cover?
Which States does Medicaid cover?
If Medicare or Medicaid covers it, will it be free?
Check Your Medicare or Medicaid Eligibility
If you are in Tampa or Florida, Tampa Weight Loss Institute can review your Medicare or Medicaid coverage and tell you exactly what you may qualify for, before you invest time into appointments, testing, or paperwork.
We confirm whether Bariatric Surgery benefits are available under your Medicare or Medicaid Plan.
We check eligibility basics (BMI, Comorbidities, and Medical Necessity requirements).
We explain what may be covered beyond Surgery, including Weight Loss Programs and Medication eligibility (when applicable).
We give you a clear checklist of next steps, required evaluations, and expected timelines.
We help you avoid delays caused by missing documentation or Plan-specific rules.