Can You Use Medicare to Pay for Weight Loss Surgeries?

Medicare to Pay for Weight Loss Surgeries? Obesity can exacerbate health problems in older adults. Excess weight increases the risk of diabetes, arthritis, heart failure, and even dementia.

Can You Use Medicare to Pay for Weight Loss Surgeries?

However, in our ‘Weight Loss Surgery Costs’ article, we point out that weight loss surgery candidates can expect to pay $20,000 to $35,000 for their procedure, which is a hefty amount for retired individuals with limited sources of income.

Can You Use Medicare to Pay for Weight Loss Surgeries?

Fortunately, eligible weight loss surgery candidates can seek help from Medicare, the government’s senior-focused health insurance plan, to cover the costs of weight loss treatment.

What does Medicare cover?

Medicare Part B can cover any Medicare-approved weight loss surgery as long as the patient is eligible, which we will cover below. Should the patient choose to recover in a hospital after surgery, Medicare Part A will cover their stay. Patients can also avail of Medicare Part D to get coverage for any necessary prescription drugs.

Weight loss surgery candidates can also sign up for Medicare Advantage, which is a Medicare bundle plan offered by private insurers. Medicare Advantage includes Parts A and B at a lower cost. Depending on the provider, the benefits offered by Medicare Advantage can also cover Part D and post-surgery maintenance costs.

For example, weight loss surgery patients under Medicare Houston receive coverage for drugs and fitness services, as well as access to nutrition experts. These can help them maintain the effects of their procedures.

what does medicare cover for gastric surgery

Which procedures are approved by Medicare?

Medicare only covers gastric bypass, duodenal switch, and gastric banding. Other weight-loss surgeries such as gastric sleeves, gastric balloon surgeries, and intestinal bypass, were not approved by Medicare because there was not enough evidence to prove that these procedures were necessary or safe.

They are a little behind the times as most decent surgeons would refuse to do a gastric band procedure. As more long-term studies have been done, the risks far outweigh the rewards on this one.

The Lap-Band can deteriorate or causes a perforation in the gastrointestinal tract, where acids and fecal matter can leak into the abdomen. Add that to the fact that they tend to break down over time? No one should be considering that as a safe option.

Who is eligible for weight loss coverage?

The Centers for Medicare and Medicaid Services ruled that Medicare can only reimburse weight loss surgery if the patient has a Body Mass Index (BMI) that is greater than or equal to 35 and has had previous unsuccessful medical obesity treatments.

How do you calculate your BMI?

How do you calculate your BMI?

Calculating BMI requires a scale, a measuring rod, and the ability to do simple arithmetic or use a calculator.

You need to know your weight in pounds, and height in inches.

The formula is pretty simple: take your weight number, divide it by your height number. Divide THAT number by your height number (yes – it is done twice). Now, take that number and multiply it by 703, and round to one decimal place.

So I used to be 5’8″ tall, or 68 inches tall. I weighed 358 pounds.

My formula would look like this:

  • 358 / 68 / 68 x 703 = ?
  • 358 / 68 = 5.26470
  • 5.26470 / 68 = .077422
  • .077422 x 703 = 54.427768 —
  • Round that to one decimal place and my pre-surgery BMI was 54.4!!

So, yeah. I was extremely obese… and am just “overweight” now at 29. I am OK with that and not looking to drop more as I am so freaking active now and reversed any possible comorbidity. I managed to drop it 25.4 points!

I have a lot more muscle mass than I used to and even if I had skin removal surgery for my excess loose skin to drop an estimated 20 more pounds, I would only drop to 27. That is STILL overweight.

(sigh)

Just check out this quick video on BMI thoughts:

Add in comorbidities

Weight loss surgery candidates must also have at least one comorbidity related to obesity — meaning they can only avail of the surgery if their obesity is linked to other health issues, such as type 2 diabetes, high blood pressure, heart disease, or sleep apnea.

Type 2 Diabetes

There are generally two types of diabetes…type 1 and 2…and even though reports show type 2 to be a little milder than type one, it still can cause some serious health conditions.

Based on reports, gastric bypass surgery has shown that it has the ability to eliminate the onset of the disease and rid it from the body. For obese patients, it is more effective and reduces the daily intake of insulin and other medications for up to three years after a successful surgery.

Gastric Bypass and High Blood Pressure

Numerous activities increase your chances of developing high blood pressure, such as having a diet high in salt or cholesterol. Other conditions that may contribute to a high BP are chronic illnesses like diabetes, kidney problems, or hereditary condition.

Having on some extra pounds could also contribute as your body might be lethargic and does not work out too often. After doing the surgery, your diet will be altered to consume less salt and fat-based foods. Also, circulation will improve, and your stress levels might also be improved.

Gastric Bypass and Obstructive Sleep Apnea

Sleep apnea is a common thing for many people, especially those who might be obese or have extra pounds than what their age and height required. Many factors cause the condition, and many people are sometimes required to use a CPAP machine while they sleep.

The idea of having your breathing following an irregular pattern of on and off during sleep can be a serious issue and should be treated to avoid further complications. Gastric bypass helps the body to lose extra weight and improve the other areas of the body.

Research has shown that more than 80 percent of people who do the surgery have had their sleep apnea disappear.

How much will the surgery cost after Medicare?

How much will the surgery cost after Medicare?

Individuals enrolled under Medicare are expected to pay deductibles for coverage to take effect. In 2021, the deductible for Part A amounted to $1,484, while the deductible for Part B was at $203.

Under Part B, patients are also expected to contribute a copay equivalent to 20% of the service’s original cost. For example, if the surgery costs $25,000, the patient would still be required to contribute $5,000 on top of their deductibles.

The cost of surgery under Medicare Advantage will vary depending on the chosen provider. It must be noted that Advantage plans are legally required to set a maximum out-of-pocket spending limit less than or equal to $7,550.

What are my other insurance options?

If you’re too young to qualify for Medicare, check whether your state’s Medicaid programs cover weight loss surgery. Medicaid Tenessee, for example, can cover gastric bypass, gastric sleeves, lap gastric bands, and duodenal switch surgery if the patient meets certain requirements. Patients are required to have a psychological evaluation and at least 5 years of documented history proving morbid obesity.

You can also shop for a private health insurance plan. As a result of the Affordable Care Act, 23 states now require insurance plans to include weight loss surgery. Georgia, Indiana, New Jersey, and Virginia also have state laws that mandate morbid obesity coverage.

Medicare is a useful tool for older adults who want to decrease the cost of healthcare expenses. Adults suffering from obesity and attributed health conditions can leverage Medicare to get the most effective recovery options at a reduced cost.

gastric bypass surgery



For more information on weight loss surgeries, check out our posts at Gastric Bypass Gal.

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Tips for Buying Second Hand Clothing

I have lost about one hundred and fifty pounds over the last year, thanks to my gastric bypass surgery and hard work. While I reversed Diabetes and lowered my blood pressure, I had one problem: I needed clothes. This “Tips for Buying Second Hand Clothing” post comes from that experience.

There is nothing like standing at the checkout line in the grocery store and having your skirt fall off of your hips. We all got a great laugh out of it and then I started to invest in clothes, not safety pins. I went from a 26-28 in woman’s to 10-14 and needed new shirts, shorts, skirts, pants and even a few dresses. I didn’t want to invest a lot of money because I was loosing weight along the way and knew that “current” wardrobe would soon be obsolete.

With the cost of clothing always rising, you may be wondering how to dress for less. Take a look below at some helpful tips for buying second hand clothing. When you follow these tips, you can still snag quality, name brand clothing while spending less. Take a look at how easy it is, no matter who you are shopping for!

I have had luck at garage sales, church sales, resell stores, and even thrift stores. All these tips work beautifully for for each different location – you just have to USE them.

Tips for Buying Second Hand ClothingTips for Buying Second Hand Clothing

1. Allow yourself some time.
When shopping at a second hand clothing store, give yourself plenty of time. You really need a good chunk of time to go through all of the items and racks piece by piece. This is the best way to be sure you see it all and aren’t missing any buried treasures. If you THINK you might like something, pop it into your cart. You can change your mind later and put it back, but if someone saw you pull it out of the rack and it caught their eye? It will be gone before you go back for it.

2. Check out labels.
Name brand clothing will always carry more value. Check the labels of the items you buy to see if they are a name brand. The item will carry more value and even get you more money when you decide to sell it back! You can also be assured that name brand items are often made with quality and durable materials. They are often made better than non-name brand items too. Hidden seams, better zippers, reinforced shoulder pads and more. They really hold up well.

3. Examine items carefully.
A damaged item is not worth purchasing. Be sure to hold all items up in good light so you can see any stains, holes, or signs of wear. Should an item have any of these signs, pass on it. If you still really want it, ask the cashier if a discount can be offered due to the damage. I forgot this rule once and brought home a $7 dress that had a small burn hole from a cigarette. WHY would someone donate that instead of just tossing it out? I have no clue but I did rescue it – the hole location was perfect to put a whimsical little decal/patch over it and make it “fun”.

4. Find available discounts.
Prior to shopping, see if the second hand store offers any discounts. Certain tags or colors may be discounted, a discount day may be offered, or they may offer a senior or student discount. Some shops even offer a discount if you bring in a donation. Find all available discounts prior to shopping and save. Not only that, some have rewards cards where you earn “dollars” for a future purchase like Saint Vincent’s.

5. Consider the basics.
It is always smart to invest in basics: black pants, a good pair of jeans, a white blouse, a navy button up sweater, and solid maxi dresses. These are items that can be worn and used in multiple ways and made to dress up or dress down. Invest in these basics that are sure to give you lots of wear.

Give these Buying Second Hand Clothing shopping tips a try and you are sure to find great second hand clothing for less!

 

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Healthy Options From Convenience Stores

When you are traveling, there are often times when you need to visit local convenience stores. This might be due to going on a road trip, taking a weekend trip where your hotel doesn’t have a restaurant, or even when traveling by bus and taking stops for a quick bite to eat.

Here are some of the healthier options available at convenience stores and gas stations.

Jerky

Jerky does contain a lot of sodium, but it is a good option when you need a snack with a lot of protein and less calories than chips or candy. Jerky is easy to eat while on the road, even while driving.

It doesn’t make a lot of mess or leave crumbs all over your car. It is also good for energy if you are driving on a big road trip. You can usually find turkey jerky, which is a little healthier than beef or steak jerky.

Granola or Protein Bars

For snacks, you should be able to find granola bars or protein bars that fit within your dietary restrictions. Most convenience stores offer a collection of bars, from low-carb protein bars, to cereal bars made with whole-grain cereal. You might find organic granola bars or those made with nuts and dried fruit. These are easy, convenient, and tasty, not to mention budget-friendly.

Fresh Fruit

It is common to have at least a limited selection of fresh fruit at gas station store and convenience stores. Even if all you find is a basket of ripe bananas at the register, it sure beats some of the other snack options! Plus, these fruits will always be non-perishable, so you can keep them in your car and enjoy them at leisure, without worrying about having a cooler ready.

Baked Chips

When you don’t have any option but to select chips, go with the baked kind. Most brands will have a baked version, offering a little less fat and calories. Pirate’s Booty is a good option, as it contains baked puffs that don’t have a lot of preservatives.

nuts and seeds from a convenience store

Nuts and Seeds

You can’t go wrong by picking up a package of nuts or seeds at the convenience store while getting gas or making a pit stop. These are usually at every convenience store or gas station, offering bags of almonds, pistachios, pecans, or assorted nuts. Sunflower seeds are often an option as well, which is good if you’re the passenger. Just don’t try to crack the seeds while you’re driving!

When all else fails, see if they have prepared food for a quick lunch, such as a sandwich with lean protein and veggies to fill up before your next stop. These foods are easy and cheap, and provide healthier options than driving through Burger King.

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Eating Healthy and Saving Money

  • Eating Healthy and Saving Money? We are often led to believe that making healthy eating habits is out of our reach for convenience and cost reasons.  But did you know that making the smarter and healthier choice can actually save you money?

Eating Healthy and Saving Money

Let me explain with these tips:

Curb your eating out and drive through habit.
This one can be tricky because it seems like if you order from the dollar or budget menu, that’s about as cheap as it gets.  Who can beat an entire meal for $3, am I right?  The trouble is, you are often buying these meals for your entire family which will likely put you over the $10 mark (and who really has a family meal for $10? You know you order extras).  If you do this even half of the week, you are looking at an extra $150 per month spent on food that is not good for you.  This is not even taking into account any sit down restaurants you go to visit, where a family meal is likely to cost $50+ and they are full of calories, sodium and more!

Cut the junk food from your shopping list.
Have you ever calculated how much you actually spend on pop, chips, frozen pizza (or other convenience meals), cookies and crackers.  None of these food provide you with good nutrition and they all cost quite a bit.  Cut these from your diet and not only will you feel  better, but your pocketbook will feel fuller!

Shop in Bulk.
Believe it or not, the bulk section carries a lot of healthy meal prep items such as oats and beans.  Both of these are incredibly healthy and are super cheap when bought in bulk.  Look for oats to be $0.70 per pound or less when bought this way and oatmeal is one of the healthiest breakfasts you can buy!

Cook More!
Cook bigger meals for dinner and use them for lunches throughout the week.  This will keep you from buying fast food or convenience type lunches and since you are eating homemade food, you are looking at a healthier meal option.  (This is a great reason to cook soups, stews and healthy casseroles)

Shop with a grocery list and don’t shop hungry.
These are two of the best tips I have ever learned while shopping.  Take a list with you and stick to it.  The more organized and prepared you are when doing your shopping, the less likely you are to buy impulse snacks and foods.  The same goes for shopping hungry.  It is proven that when we shop hungry, we spend more money.  Our hunger often makes us grab foods we wouldn’t normally shop for.  That hunger also talks us into those near-the-checkout impulse buys that are right at our fingertips, like candy bars and snack sized foods that are far from healthy!

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5 Ways To Eat Organic On A Budget

OrganicBudget

Five Ways to Eat Organic on a Budget

In this day and age, when most of our food supply is genetically-modified and/or doused with pesticides, buying organic is more important than ever. However, organic food can be expensive and many people may feel overwhelmed by the idea of switching from conventionally-grown food to organically-grown. While it is pricey, there are ways to eat organic on a budget. Check out these five tips to help you save money on organic food.

  1. Buy in Bulk

Many big box and warehouse stores sell organic food in bulk. This comes in handy when purchasing individually-wrapped organic snacks for school, such as granola bars, or mini bags of popcorn. You can also buy bulk amounts of organic food at many supermarkets where bins full of cereals, nuts, and dried fruits are available to purchase by the pound. And lastly, online is another way to go. Simply search “bulk organic food” and you’ll find great deals.

  1. Grow Your Own

Even if you don’t have a green thumb, or the space to grow large amounts of fruits and vegetables, everyone has room for a few pots of dirt in which to grow organic herbs. Herbs such as basil, oregano, cilantro, and dill are all easy to grow indoors and nothing could be fresher than clipping your own fresh herbs to add to a recipe. If you have the room for more containers, or the land to grow produce, do so. Just be sure you buy organic seeds and use organic soil when planting.

  1. Coupon

A lot of people are under the misconception that no coupons exist for organic food. This is simply untrue. Check the flier when you enter a store to see if there are coupons for the organic food you’re seeking to purchase. Also, go straight to the source by checking the website of a particular brand you want to buy. You can also write to the company who owns the brand you’re interested in and ask for a coupon or discount. It’s worth a try!

  1. Join a CSA

Research local certified-organic farms and find one that offers a CSA. CSA stands for “community supported agriculture”. Various families from your community “buy in” to a CSA to support the farmer’s time, labor, and supplies, and in return, they get a share of the harvest. CSAs are a wonderful way to try new foods and recipes that you normally wouldn’t, because often, the weekly shares are pre-boxed by the farmer with whatever s/he has on hand. If there isn’t a certified-organic farm in the area, contact local farms to ask if they use organic practices to grow their food. Many do and simply don’t want to pay the fees to become officially certified.

  1. Buy Local

If you’re not interested in the commitment required by joining a CSA, you can still reap the rewards of buying from local organic farms, or at regional farmer’s markets. This allows you to buy what you want, and the amount appropriate to your family’s needs. Try going to the market closer to closing time as farmers often discount produce, eggs, meat and other items so they don’t have to pack it up and bring it back home.

Buying organic on a budget is completely possible. Using these tips, you’ll be able to save money while feeding your family the healthiest food available. Eating organic food may be more expensive than conventional food, but the benefit to your health is priceless!

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10 Cheap & Healthy Foods

It’s rare that the words cheap and healthy can be used to describe food and what we buy in the supermarket.  But it is doable to watch what we eat and stay on a budget as well by simply stocking up on healthy options especially when they are on sale.  Below are just 10 of some cheap and healthy foods to stock up on now.

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10 Cheap & Healthy Foods

  1. Canned tuna.
    Packed with protein and omega-3, tuna is a must have in your pantry for cheap and healthy meals.  Added to salads or mixed with a light or fat free mayonnaise, tuna is a great bet.
  2. Dried Beans.
    So many beans, so little time.  Buying and preparing dried beans is not only inexpensive but they can be used in so many recipes.

    ten healthy things to eat dried beans

  3. Whole grain pasta.
    Again, the variety is endless in the pasta aisle. Not only is whole grain pasta more nutritious than regular pasta, but it is usually the same price as well.
  4. Frozen vegetables.
    What a great stock up item when these go on sale.  Used a side dish with a healthy meal or added to soups and stews, frozen vegetables can do no wrong in your freezer and are always there for you.
  5. Bagged spinach.
    Surprisingly, this produce item is so cost effective and typically on sale especially in the summer months.  It’s always ready to go, lasts about a week in it’s own bag when sealed properly, and is great for salads and also sauteed for a quick healthy side dish.
  6. Whole wheat bread.
    Whole grain and whole wheat bread is an excellent choice to always have around.  When they are buy one, get one, stock up and freeze extra loaves to save money and always have available.

    10 Cheap & Healthy Foods eggs

  7. Eggs.
    This amazing food is not only a healthy one but super inexpensive too.  Breakfast, lunch, and dinner calls for any type of egg recipe.
  8. Sweet potatoes.
    Either served sweet with butter and cinnamon or savory with some spices, sweet potatoes are super for sides and a light lunch. Rich in vitamins and nutrients, simply bake and serve.
  9. Canned salmon.
    We often buy tuna, why not canned salmon?  Make salmon cakes or add to salads and get a ton of protein and omega-3’s in your diet.
  10. Greek yogurt.
    Now that greek yogurt varieties are endless the dairy aisle, stock up when they are on special.  They make a great healthy snack and are portable especially when you are on the go.

I hope this quick list of cheap & healthy foods helps stretch your budget — if you think I missed something, please share!

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