Yes, Medicare covers weight loss (bariatric) surgery if you meet 3 rules: your BMI is 35 or higher, you have at least one health problem linked to obesity, and you tried medical treatment for obesity before without success (CMS National Coverage Determination 100.1). Part B covers the surgeon, and Part A covers the hospital stay if you’re admitted.
Medicare won’t pay for surgery for weight alone, and it never covers a few procedures, like the gastric balloon. Here’s exactly what counts, what you’ll pay in 2026 and how to get approved.
The 3 rules, in plain words
1. BMI of 35 or higher. BMI (body mass index) compares weight to height. For example, a person who is 5 feet 6 inches is at a BMI of 35 at about 216 pounds. Your doctor will measure and record it.
2. At least one obesity-related health problem. This is called a “co-morbidity.” CMS has said type 2 diabetes counts. Others your doctor may document include high blood pressure, sleep apnea, heart disease and severe joint problems.
3. Earlier medical treatment didn’t work. You need records that show you tried to lose weight with a doctor’s help. That could be a diet plan, counseling or medicine. It didn’t work well enough. Medicare doesn’t set a national number of months. Your local Medicare contractor or your plan may have more detailed rules, so ask.
What doesn’t qualify: CMS says surgery for people with type 2 diabetes and a BMI under 35 is not covered. “Treatments for obesity alone” are not covered either.
Which surgeries Medicare covers
Under CMS’s national rule, these are covered when you meet the 3 rules:
- Roux-en-Y gastric bypass, open or laparoscopic (through small cuts)
- Biliopancreatic diversion with duodenal switch, open or laparoscopic
- Laparoscopic adjustable gastric banding (the “lap band”)
Laparoscopic sleeve gastrectomy (removing most of the stomach to make a narrow “sleeve”) is decided by your local Medicare contractor, using the same 3 rules. Ask the surgeon’s office to confirm coverage in your area before you schedule.
CMS says these are never covered:
- Open adjustable gastric banding
- Open sleeve gastrectomy
- Vertical banded gastroplasty
- Intestinal bypass surgery
- Gastric balloon for obesity
Since 2013, the hospital doesn’t need a special bariatric certification for Medicare to pay. Still, I’d pick a surgeon and hospital that do many of these operations and have a full follow-up program.
What you’ll pay in 2026
Your costs depend on if you’re admitted to the hospital or have the surgery as an outpatient. Medicare.gov says to ask the doctor and hospital up front, and to check if you’re an inpatient (Medicare.gov).
With Original Medicare, if you’re admitted:
- $1,736 Part A deductible for the hospital stay (per benefit period)
- $283 Part B deductible if you haven’t met it this year
- 20% of the Medicare-approved amount for the surgeon, the anesthesia doctor and other doctor services
If it’s done as an outpatient, you pay 20% of the approved amount after the Part B deductible, for both the facility and the doctors.
A Medigap policy can pay most or all of these. Plan G, for example, pays the Part A deductible and your 20%. Our Medigap plans comparison explains each plan. For more on hospital costs, see our Medicare hospital stay guide.
With Medicare Advantage, you’ll pay your plan’s copays, and you’ll almost always need prior authorization. That means your surgeon asks the plan to approve the surgery first. You’ll also need to use in-network surgeons and hospitals in most plans.
What Medicare won’t pay: Medicare.gov notes it doesn’t cover your travel to a bariatric center.
Steps to get approved
- Talk to your primary care doctor. Ask them to record your BMI, your health problems and your past weight loss attempts.
- Start a supervised weight loss program if you don’t have one in your records. Medicare covers obesity behavioral therapy with your primary care provider if your BMI is 30 or more. You pay nothing if the provider accepts assignment (Medicare.gov).
- See a bariatric surgeon who accepts Medicare or is in your plan’s network.
- Expect tests and visits before surgery, often including a nutrition review and a mental health check.
- Get prior approval in writing if you have Medicare Advantage.
- Get a cost estimate from the hospital and surgeon. Ask whether you’ll be inpatient or outpatient.
If you’re denied, ask why in writing. Missing records are a common reason. Our Medicare appeals guide shows how to appeal.
Who should think hard before surgery
Bariatric surgery is a major operation. It can work well, but it’s not for everyone. Talk carefully with your doctors if you:
- Have serious heart or lung disease that raises surgery risk
- Can’t commit to lifelong vitamins, diet changes and follow-up visits
- Have an active eating disorder or untreated depression
- Are frail or have trouble with daily activities, since recovery takes strength
Ask your surgeon what vitamins, diet rules and follow-up visits you’ll need after surgery, and for how long. For many people, it’s for life.
The drug option: $50 GLP-1s through the GLP-1 Bridge
Surgery isn’t the only path now. Since July 1, 2026, Medicare’s GLP-1 Bridge lets eligible people with Part D get Wegovy, Zepbound KwikPen or Foundayo for weight loss for a $50 copay per monthly supply. It runs through December 31, 2027 (CMS).
To qualify, your provider must send a prior authorization showing, for example, a BMI of 35 or more, or a lower BMI with certain conditions. The $50 doesn’t count toward your Part D deductible or out-of-pocket limit. Our GLP-1 and Medicare guide has the full rules.
Which is better? That’s a talk for you and your doctor. Surgery is a one-time operation with lasting changes. The drugs avoid surgery but must be taken long term, and the Bridge is set to end after 2027.
Common questions
What BMI do you need for Medicare to cover weight loss surgery?
A BMI of 35 or higher, plus at least one obesity-related health problem and a record of failed medical weight loss treatment.
Does Medicare cover gastric sleeve surgery?
Laparoscopic sleeve gastrectomy is decided by your local Medicare contractor using the same 3 rules. Open sleeve surgery is never covered.
How much does weight loss surgery cost with Medicare?
If you’re admitted, you pay the $1,736 Part A deductible, plus 20% of doctor costs after the $283 Part B deductible in 2026. Medigap can cover most of that.
Does Medicare cover the gastric balloon?
No. CMS lists the gastric balloon for obesity as never covered.
Does Medicare cover weight loss drugs instead of surgery?
Yes, for some people. The Medicare GLP-1 Bridge offers certain GLP-1 drugs for $50 a month from July 2026 through 2027 if you qualify.
Written by Khasim Basha Shaik. I research and compare Medicare coverage rules for readers. I am not a licensed insurance agent or medical professional. This article summarizes CMS and Medicare.gov materials and is not medical advice. Talk to your doctor about your own health. Last reviewed October 18, 2026.
