People With Medicare
Obesity Screening and Counseling
What it is:
Obesity is a condition in which you have an unusual amount of body fat that can put your health in danger. Obesity can lead to other chronic diseases, such as cardiovascular (heart) disease and diabetes.
Obesity is usually influenced by a person's lifestyle and level of activity, meaning a person eats more calories than is burned and does not get enough exercise. However, there are other reasons a person may become obese, such as:
- age (your body's metabolism slows down as you get older),
- gender (women tend to be more overweight than men),
- family history of obesity,
- illnesses such as depression and hypothyroidism, and
- medications such as steroids that can lead to weight gain.
There are many ways to find out if you are obese. The most common is by calculating your body-mass index, or BMI. BMI is a calculation your doctor can do using your height and weight. BMI can help tell you if you are at a healthy weight for your height:
- a BMI between 25-29.9 is considered overweight
- a BMI of 30 or higher is considered obese
There are other ways to determine if you are obese such as measuring your waist, measuring waist-to-hip circumferences, and techniques such as ultrasounds. However, BMI is the most commonly used and is covered by Medicare.
Why the screening is important:
Obesity has become a major health concern in the U.S. Almost 1 in 3 people with Medicare is estimated to be obese. Obesity is also more likely to affect people of minority groups such as African-Americans and Latinos. This screening can help you get treatment to improve your quality of life.
How often it is covered:
Medicare covers the cost of one screening per year for anyone who has Medicare Part B and gets this service while in a primary care setting, such as a doctor's office.
Intensive Counseling Sessions to Help You if You are Obese
And, if you screen positive for obesity (a BMI of 30 or higher), Medicare will cover intensive counseling sessions with your doctor, for up to year, to help you learn and review ways to reduce your weight and improve your overall health.
Medicare will cover:
- one face-to-face counseling session each week for the first month,
- one face-to-face counseling session every other week for months 2-6, AND
- one face-to-face counseling session every month for months 7-12, if you continue to meet the weight loss goals established with your doctor.
What you pay:
You pay nothing for cost of this service if you have Original Medicare and you see a doctor who "accepts assignment." Doctors who accept assignment agree to accept the amount that Medicare will pay for a visit or service (called the Medicare-approved amount) as payment in full.
If you are in a Medicare Advantage plan, you need to check with your plan - copayments and a deductible may apply.
Learn more about Obesity Screening and Counseling on Medicare.gov.
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