Medicare covers intensive Behavioral Therapy for Obesity if you have a Body Mass Index (BMI) of 30 or higher.
Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). Plans cover this type of therapy for obesity.
Medicare will cover an obesity screening, nutritional assessment, and up to 22 face-to-face sessions.
Sessions must be completed by a qualified primary care physicianA Primary Care Physician is a doctor that oversees and monitors your medical care under some plan types. PCPs also may be responsible for referrals to specialists., other practitioners, or in a primary care setting.
You must meet a 6.6-pound weight loss goal in the first six months to continue receiving Intensive Behavioral Therapy for Obesity. If not, you may be able to try again after an additional six months.
Yes — if you have Medicare, obesity counseling is covered — but you must qualify, and the counseling must follow certain guidelines. If you’re eligible for this program, known as Intensive Behavioral Therapy for Obesity, Medicare will cover it as a preventive service.
Let’s face it, gaining a few pounds as we age is not unexpected. A slowing metabolism, aching joints and decreased energy are just why it gets tougher to maintain our physical health. However, you shouldn’t take added weight lightly; gaining too much can cause serious cardiovascular disease and diabetes issues as we get older.
If you’re on Medicare and obesity is a concern, you may qualify for Intensive Behavioral Therapy. To see if you can use your Medicare coverage for obesity counseling, here’s an overview of how it works and what to expect.
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Intensive Behavioral Therapy for Obesity is a structured approach to weight loss based on replacing bad habits with healthier behaviors. Instead of crash dieting or simply focusing on physical training, Intensive Behavioral Training teaches you how to sustain a healthy weight. To do so, you’ll identify and change the routines that cause you to gain weight. As part of your counseling,
- You will receive a weight screening to measure your Body Mass Index (BMI). To calculate BMI, divide your weight (kilograms) by the square root of your height (meters). You must have a BMI of 30 or higher to qualify for Intensive Behavioral Therapy, Medicare guidelines state.
- You receive a dietary assessment to gauge your nutritional levels and habits.
- You receive in-person, intensive counseling focusing on your specific diet and exercise.
For your in-person counseling to be considered Intensive Behavioral Therapy for Obesity, Medicare guidelines require a specific framework. According to the Centers for Medicare & Medicaid Services (CMS), this counseling must follow these five steps:
- Assess: Discuss what steps you can take to get healthier, as well as the obstacles that may get in your way. Your assessment helps devise a plan that works for you.
- Advise: The counseling must give clear advice that’s personalized for you. The guidance should be specific and help you weigh the health benefits and risks.
- Agree: Now that you’ve gotten advice and spotted potential obstacles, it’s not time to collaborate on your goals and the methods you’ll use to reach them. At this step, you and your doctor will develop a plan you both agree is manageable.
- Assist: Your doctor will teach you behavior-changing techniques and provide counseling to help you meet your goals. Assistance also may mean medical treatments when appropriate.
- Arrange: continued support and follow-up sessions. You’ll meet with your doctor in person or over the phone for ongoing assistance and to adjust your plan if needed.
Your Intensive Behavioral Therapy for Obesity also must be performed by a qualified primary care physician or by another qualified provider in a primary care setting. Primary care settings can include your physician’s office, health clinics, and outpatient hospitals. If you receive your counseling from a non-qualified provider or in a non-approved setting, you may be denied Medicare coverage for the obesity counseling.
Yes, Medicare covers several services for beneficiaries who are overweight or obese — not just Intensive Behavioral Therapy. If you have Medicare, you may qualify for options that also include SilverSneakers, a Diabetes Prevention Program, and even bariatric surgery. Each program can lower the risk for illness and injury and improve overall health.
Why does Medicare cover these services and programs? Obesity can lead to several serious health issues, many of which are avoidable by adopting healthier living habits. These conditions are costly both for the beneficiary and for Medicare. Unfortunately, there’s also a risk that they could become prevalent. A recent study by the CDC showed that medical costs are significantly higher for obese patients. The obesity rate for U.S. adults is 42.4%, and 42.8% of obese adults are age 60 and above.
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If you qualify for Intensive Behavioral Therapy for Obesity, Medicare will cover up to 22 IBT sessions over 12 months. How many sessions you ultimately receive will come down to your participation and progress in the program. If you meet specific goals as you go, you’ll continue to receive counseling. Here’s how it works.
- One face-to-face visit per week
Months 2 to 6
- Once face-to-face visit, every other week
Months 7 to 12
- After the first six months, you must lose 3 kilograms, which equals 6.61 pounds. If you meet this goal, Medicare will cover one face-to-face visit per month.
Failing to meet the 3-kg goal won’t keep you from receiving obesity counseling from Medicare forever. After an additional six months, you can talk to your doctor about trying again. At that time, Medicare will reassess your BMI and readiness to change.
What extra benefits and savings do you qualify for?
If you’re enrolled in Medicare and have a BMI of 30 or higher, your obesity and nutritional screenings, and all of your Intensive Behavioral Therapy sessions are covered. Whether you have Original Medicare (Parts A and B) or Medicare Advantage Plan (Part C), preventive services are covered to improve outcomes in patients by spotting illnesses and health conditions before they become serious.
To recap, Medicare does cover Intensive Behavioral Therapy for Obesity. This service is available to Medicare beneficiaries who have a Body Mass Index of 30 or higher. Medicare covers it as a preventive service. You can receive 22 Intensive Behavioral Therapy sessions over 12 months but must meet a weight-loss goal after the first six months to continue with your therapy.
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