If you fulfill the requirements, Medicare will pay for your lap band (laparoscopic banding) procedure. The services you require and the particular coverage you have can affect your out-of-pocket expenses.
Medicare often pays for lap band surgery, also known as laparoscopic banding surgery, for obese patients who satisfy all eligibility criteria.However, the surgery can come with out-of-pocket expenses. These expenses could change based on:
- location your surgery is carried out—in a hospital or an outpatient clinic
- your particular coverage, including Medicare Advantage (Part C) plans or Original Medicare (Parts A and B)
- whether you are covered by additional insurance, like a Medigap policy
If you have Medicare, continue reading to find out more about the costs, coverage, and eligibility for lap band surgery.
Who is eligible for lap band surgery under Medicare?
Medicare will pay for bariatric surgery (gastric bypass and lap band surgery) provided you meet all the conditions. Among the prerequisites are:
- having a BMI (body mass index) of more than 35
- possessing at least one additional obesity-related medical condition
- having tried unsuccessful medical therapies for obesity in the past
The cost of the procedure and any associated services will be covered by Original Medicare and Medicare Advantage plans if you meet these criteria.
These costs can include:
- medical consultations associated with the procedure
- testing (including laboratory testing) as necessary both before and after the procedure
- your hospital stay—should the surgery take place in a hospital—
- any prescription drugs or durable medical equipment you require as you heal
How much will I pay for lap band surgery with Medicare?
Most of the costs associated with lap band surgery are usually covered by Medicare if you fulfill the eligibility conditions. The precise amount you must pay out-of-pocket for Medicare lap band surgery will depend on the particular treatments you require.
For instance, certain patients might need to stay in the hospital longer or must drop a specific amount of weight before surgery. You can get an idea of the services your surgeon and the surgical team think you'll require before, during, and following surgery.
Generally speaking, you should budget for the usual out-of-pocket expenses. By 2024, these might consist of:
- Part A deductible: Every time you are admitted to the hospital, you are required to pay a $1,632 deductible.
- Part A coinsurance: You will be responsible for additional coinsurance charges of $408 per day if you stay in the hospital for longer than 60 days but less than 90 days.
- Part B deductible: When using Part B coverage, there is an annual $240 Part B deductible.
- Part B coinsurance: You pay a Part B coinsurance fee of 20% of each service after paying your deductible.
- Part D (drug coverage) deductible: You are responsible for covering the cost of your Medicare Part D deductible if you need prescription drugs. Each plan has a different price.
Some of these expenses can be covered by your Medigap plan if you have extra coverage.
A Medicare Advantage plan might potentially pay for extra services related to weight loss or lap band surgery.
Financial aid programs that assist with these out-of-pocket expenses may also be available to you.
Takeaway
If you satisfy all of the requirements, Medicare will pay for lap band surgery as well as other forms of bariatric surgery.
Coinsurance and copays are among the out-of-pocket expenses that you still have to pay. Assistance programs or Medigap policies could help pay for part of these expenses.
0 Comments