Medicare Proposes Coverage of Bariatric Surgery for Non-Elderly Beneficiaries

BALTIMORE–A new proposal would cover bariatric surgery for
obese Medicare beneficiaries under age 65, but would end coverage
of the procedure for seniors.

CMS currently covers bariatric surgery, including gastric
bypass, for beneficiaries of all ages as a treatment for a
co-morbidity–including hypertension, type 2 diabetes, stroke and
sleep apnea–but not obesity alone.

The agency said it proposes not covering bariatric surgery for
those 65 and older, except for patients in clinical trials, because
recent studies indicate significant surgical risks in the elderly
population. According to a recent study by David R. Flum, Early
Mortality Among Medicare Beneficiaries, seniors had two-fold to
three-fold higher death rates after bariatric surgery compared with
other individuals. About 13 percent of men and 6 percent of women
65 to 74 died within a year of the surgery. In patients 75 and
older, half of the men and 40 percent of women died within the
year.

For the younger population, there is evidence that the surgery
produces benefits for those who have at least one obesity-related
health problem and have been unsuccessful with previous medical
treatment, according to CMS.

“While the best proven ‘treatment’ is a nutritious diet and
regular exercise, and medical treatments are also available, some
beneficiaries may significantly reduce their health risks through
surgery,” said CMS Administrator Dr. Mark McClellan.

To submit comments on the proposal, visit www.cms.hhs.gov/coverage.