On November 29, 2011, CMS announced its decision to include coverage for obesity screening and counseling services for Medicare beneficiaries. This new coverage for Medicare beneficiaries is another tool aimed at emphasizing prevention and wellness by CMS, which has already implemented coverage of certain preventive services and screenings as part of the Affordable Care Act.
An estimated 30% of men and women in the Medicare program are considered medically obese, defined as having a Body Mass Index (BMI) of at least 30 kg/m.² Patients who are obese are at higher risk of developing other chronic conditions, including heart disease and diabetes.
What is Covered
Beneficiaries eligible for Medicare Part A or Medicare Part B are entitled to preventive weight-control services including screening for obesity, dietary assessment, and behavioral counseling or therapy to promote sustained weight loss.
For beneficiaries with obesity as defined above, Medicare will cover:
- One face-to-face visit every week for the first month;
- One face-to-face visit every other week for months 2-6;
- One face-to-face visit every month for months 7-12, if the beneficiary meets a 3kg (6.6 pounds) weight loss requirement
The beneficiary must be re-assessed at the six month visit, where a determination of amount of weight lost must be performed. If the beneficiary has achieved a weight loss of at least 6.6 pounds, CMS will continue to cover additional face-to-face visits once per month for an additional six months. If the beneficiary has not achieved weight loss of at least 6.6 pounds, they can be reassessed for BMI and lifestyle changes after a six month period.
Costs and Disparities
Medicare and private insurers currently pay more for patients with obesity than for patients with normal weight. Preventing obesity through screening and counseling will help bring down overall healthcare costs by preventing the development of such obesity-related chronic conditions as cardiovascular disease, diabetes, kidney disease, and more. Advocates should be aware of this new addition to Medicare’s free preventive services and should reach out to their networks to help inform beneficiaries and their families of this important benefit.
 CMS Press Release available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4189&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr
 See §4104(a) of the Affordable Care Act (ACA), Pub. L. 111-148 (March 30, 2010), inserting preventive services in §1861(ddd) of the Social Security Act, 42 U.S.C. §1395x(ddd).
 See the full decision on the national coverage determination at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253&
 Finkelstein EA, Trogden JG, Cohen JW, Dietz W. "Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates." Health Affairs. 2009; 28(5):w822-w831.