Does Medicare Cover Bariatric Surgery in 2026?

Full answer: Yes. Medicare covers bariatric surgery, including gastric bypass, laparoscopic gastric banding, and laparoscopic sleeve gastrectomy, when you have a BMI of 35 or higher, at least one obesity-related comorbidity such as type 2 diabetes, and documented failed attempts at medical weight-loss treatment. These national rules come from Medicare National Coverage Determination 100.1, so the criteria are identical in every state. Original Medicare pays 80% of the Medicare-approved cost after you meet your 2026 Part A and Part B deductibles.

More than 40% of American adults over 60 live with obesity, and for many of them diet and exercise alone have not been enough to resolve the type 2 diabetes, sleep apnea, or heart disease that comes with it. Bariatric surgery without insurance can cost $9,500 to $35,000 depending on the procedure, so knowing exactly what Medicare pays for matters before you talk to a surgeon.

CoveredUSA breaks down the 2026 BMI and comorbidity rules that determine coverage in this guide, which procedures Medicare pays for and which it does not, what Medicare Advantage plans add on top of Original Medicare, and what to do if you do not meet the surgery criteria yet. For the drug alternative, see does Medicare cover GLP-1 weight loss drugs. Check your Medicare eligibility if you are not yet enrolled.

Coverage Breakdown

Coverage by type
Plan Type	Bariatric Surgery Coverage	What You Pay	Extra Benefits
Original Medicare (Part A & Part B)	Yes, when NCD 100.1 criteria are met	20% Part B coinsurance plus the 2026 Part A ($1,736) and Part B ($283) deductibles	None; surgeon and facility must accept Medicare assignment
Medicare Advantage (Part C)	Yes, same medical criteria at minimum	Varies by plan; capped by the 2026 in-network out-of-pocket maximum of $9,250	Some plans add dietitian visits, SilverSneakers, and post-op supplies
Medigap (Medicare Supplement)	Partial: pays cost-sharing only	Depends on plan letter; can reduce or eliminate the 20% coinsurance	No new bariatric benefit; only offsets Original Medicare's cost-sharing
Self-pay or employer supplemental (if you don't meet criteria)	No Medicare role	Full self-pay price, $9,500 to $35,000 in 2026, unless private insurance covers it	Some bariatric centers offer in-house financing plans

This 2026 plan-type breakdown reflects coverage under a single national policy, Medicare NCD 100.1, so eligibility criteria are the same in all 50 states even though Medicaid's bariatric surgery rules vary widely by state.

Source: CMS National Coverage Determination 100.1, Medicare.gov, KFF Medicare Advantage in 2026 report

Direct Answer

Yes. Medicare covers bariatric surgery, including gastric bypass, laparoscopic gastric banding, and laparoscopic sleeve gastrectomy, when you have a BMI of 35 or higher, at least one obesity-related comorbidity such as type 2 diabetes, and documented failed attempts at medical weight-loss treatment. These national rules come from Medicare Coverage Determination 100.1, so criteria are identical in every state. Original Medicare pays 80% of the approved cost after you meet your 2026 Part A and Part B deductibles.

What Original Medicare Covers for Bariatric Surgery

Original Medicare covers bariatric surgery under National Coverage Determination 100.1 when you meet three conditions: a body mass index of 35 or higher, at least one obesity-related comorbidity, and documented previous unsuccessful medical treatment for obesity such as a physician-supervised diet and exercise program. Recognized comorbidities include type 2 diabetes (added as a qualifying condition on February 12, 2009), hypertension, obstructive sleep apnea, and cardiovascular disease. Covered procedures are open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. Laparoscopic sleeve gastrectomy has been eligible for coverage since June 27, 2012, but the final decision is made by your regional Medicare Administrative Contractor rather than the national policy.

Medicare removed the requirement that surgery be performed at a certified Center of Excellence effective September 24, 2013, after evidence showed outcomes at non-certified facilities were comparable. Your surgeon and facility must still be enrolled in Medicare and bill under Medicare Part A (inpatient) and Medicare Part B (surgeon and anesthesia fees). Procedures Medicare does not cover under NCD 100.1 include open sleeve gastrectomy, vertical banded gastroplasty, gastric balloon placement, and intestinal bypass surgery, regardless of your BMI or comorbidities.

Bariatric procedures covered by Medicare, by status (2026)
Procedure	Coverage Status	Notes
Roux-en-Y gastric bypass (open or laparoscopic)	Covered	Most common covered procedure nationally
Laparoscopic adjustable gastric banding (LAGB)	Covered	Fewer surgeons offer it than in past years
Biliopancreatic diversion with duodenal switch	Covered	Reserved for BMI 50+ in most practices
Laparoscopic sleeve gastrectomy	Covered by local contractor	Decided by your regional MAC, not the national policy
Open sleeve gastrectomy	Not covered	Excluded under NCD 100.1
Vertical banded gastroplasty	Not covered	Considered outdated by CMS
Gastric balloon	Not covered	Not addressed as a covered benefit

Coverage status applies nationally except where noted as a local contractor decision.

Source: CMS National Coverage Determination 100.1, CMS LCD L35022

What Medicare Advantage May Add in 2026

Medicare Advantage (Part C) plans must cover bariatric surgery whenever Original Medicare would, using the same BMI, comorbidity, and prior-treatment criteria set by NCD 100.1. Plans cannot impose stricter medical necessity rules, though most do require prior authorization before scheduling surgery, which Original Medicare does not require. In 2026, CMS caps in-network out-of-pocket spending on Medicare Advantage plans at $9,250, so even a high-cost gastric bypass admission cannot push your annual costs above that ceiling once you hit it.

Some Medicare Advantage plans add supplemental benefits beyond what Original Medicare pays for, such as additional registered dietitian visits, SilverSneakers gym memberships to support post-surgical activity, meal delivery after discharge, and telehealth follow-up visits with your surgical team. These extras vary widely by plan and county, so compare specific plan documents rather than assuming every Medicare Advantage plan offers the same add-ons.

Cost Without Coverage in 2026

Bariatric surgery without any insurance coverage in 2026 typically costs $9,500 to $23,000 for a laparoscopic sleeve gastrectomy, $15,000 to $35,000 for a Roux-en-Y gastric bypass, and $20,000 to $35,000 for a biliopancreatic diversion with duodenal switch, depending on your region and whether the price is an all-inclusive package. When Medicare covers your surgery, you instead pay the 2026 Part A inpatient hospital deductible of $1,736 if you are admitted, plus 20% coinsurance on Part B physician and anesthesia charges after the $283 Part B deductible, a fraction of the full self-pay price.

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Eligibility Criteria for the Bariatric Surgery Benefit

To qualify for Medicare-covered bariatric surgery, you need documented proof of three things in your medical record before your surgeon submits a claim. First, a BMI of 35 or higher, calculated and recorded by a physician, not self-reported. Second, at least one obesity-related comorbidity such as type 2 diabetes, hypertension, obstructive sleep apnea, or cardiovascular disease. Third, evidence that medically supervised weight-loss attempts, such as a structured diet and exercise program, failed to achieve or maintain adequate weight loss. Most surgeons also require a pre-operative psychological evaluation and a nutrition consultation, which are surgeon-driven best practices rather than strict Medicare requirements, but skipping them often delays approval.

How to Find a Surgeon and Facility That Accepts Medicare

Start by asking your primary care doctor for a referral to a bariatric surgeon, since a documented history of medically supervised weight-loss attempts usually comes from your primary care record. Next, use Medicare's Care Compare tool at medicare.gov/care-compare to confirm the surgeon and hospital accept Medicare assignment, meaning they accept the Medicare-approved amount as full payment. Ask the surgical practice directly whether they participate with Medicare and whether they require prior authorization if you are enrolled in a Medicare Advantage plan. Finally, confirm which pre-operative steps, such as a supervised diet program or psychological evaluation, the practice requires before they will submit your case for approval.

Related Medicare Benefits If You Don't Meet the Surgery Criteria

If your BMI is below 35 or you lack a qualifying comorbidity, Medicare Part B still covers Intensive Behavioral Therapy for obesity at no cost to you when your BMI is 30 or higher, under a separate policy, NCD 210.12. This benefit provides up to 22 face-to-face counseling visits over 12 months in a primary care setting, with weekly visits in month one, biweekly visits in months two through six, and monthly visits in months seven through twelve if you lose at least 3 kilograms in the first six months.

Medicare Part D beneficiaries also have a new option starting July 1, 2026: the Medicare GLP-1 Bridge program lets eligible enrollees fill Wegovy, Zepbound, or Foundayo for a $50 copay per 30-day supply through December 31, 2027, through participating Part D plans. This is a temporary demonstration, not a permanent Medicare drug benefit, and it does not replace bariatric surgery for beneficiaries who meet NCD 100.1's criteria. If you are also enrolled in Medicaid as a dual-eligible, many state Medicaid programs cover bariatric surgery under their own, often less restrictive, BMI rules; see does Medicaid cover weight-loss surgery for state-by-state detail.

Frequently Asked Questions

Does Original Medicare cover gastric bypass surgery?

Yes. Original Medicare covers open and laparoscopic Roux-en-Y gastric bypass under NCD 100.1 when you have a BMI of 35 or higher, at least one obesity-related comorbidity, and documented failed medical weight-loss treatment. You pay the 2026 Part A deductible of $1,736 for the hospital stay plus 20% Part B coinsurance for surgeon and anesthesia fees after the $283 Part B deductible.

Does Medicare cover gastric sleeve (sleeve gastrectomy) surgery?

Usually yes. Laparoscopic sleeve gastrectomy has been eligible for Medicare coverage since June 27, 2012, but unlike gastric bypass, the final decision is made by your regional Medicare Administrative Contractor rather than the national NCD 100.1 policy. Open sleeve gastrectomy is not covered under any circumstance. Confirm coverage with your surgeon's billing office before scheduling.

What BMI do I need to qualify for Medicare bariatric surgery coverage?

You need a physician-documented BMI of 35 or higher, plus at least one obesity-related comorbidity such as type 2 diabetes, hypertension, or obstructive sleep apnea, plus proof that a medically supervised weight-loss attempt failed. All three conditions must be met and documented in your medical record before Medicare will cover the surgery.

Does Medicare Advantage cover bariatric surgery differently than Original Medicare?

Medicare Advantage plans must use the same BMI and comorbidity criteria as Original Medicare, but most add a prior authorization requirement that Original Medicare does not have. In 2026, Medicare Advantage plans also cap your in-network out-of-pocket costs at $9,250, and some add extra benefits like dietitian visits or SilverSneakers gym access.

How much does bariatric surgery cost without Medicare coverage in 2026?

Self-pay prices in 2026 range from $9,500 to $23,000 for a laparoscopic sleeve gastrectomy, $15,000 to $35,000 for a Roux-en-Y gastric bypass, and $20,000 to $35,000 for a biliopancreatic diversion with duodenal switch, depending on your region and whether facility, anesthesia, and follow-up care are bundled into one price.

Does Medicare require a certified bariatric center for surgery?

No. Medicare removed the requirement that surgery be performed at an ACS-certified or ASMBS-certified Center of Excellence effective September 24, 2013. Your surgeon and facility only need to be enrolled in Medicare, though many still voluntarily hold accreditation.

What if I don't meet Medicare's BMI or comorbidity requirements for bariatric surgery?

If your BMI is 30 or higher but below 35, Medicare Part B covers Intensive Behavioral Therapy for obesity at no cost, with up to 22 counseling visits over 12 months under NCD 210.12. Starting July 1, 2026, the Medicare GLP-1 Bridge program also lets eligible Part D beneficiaries access Wegovy, Zepbound, or Foundayo for a $50 monthly copay through December 31, 2027.

Does Medicare cover skin removal surgery after bariatric surgery?

Only in narrow medical circumstances. Medicare covers panniculectomy or other excess skin removal after major weight loss when documented medical problems exist, such as recurrent rashes, infections, or skin breakdown under a skin fold, not for cosmetic appearance alone. Your surgeon must submit photo documentation and a medical necessity letter.