Does job-based or Marketplace insurance cover weight-loss surgery?

Usually covered if you meet strict criteria: about 6 in 10 employers include weight-loss surgery. Plans that cover it usually require a BMI of 40 or more (or 35 or more with a condition such as diabetes, sleep apnea, or heart disease), a supervised program before surgery, and a psychological evaluation, with prior authorization. Some HMO plans exclude it, and Marketplace plans follow their state’s benchmark plan. Cost: Inpatient surgery cost sharing: your deductible, then coinsurance up to your out-of-pocket maximum.

Does Original Medicare cover weight-loss surgery?

Yes, for a BMI of 35+ with a related condition. Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered.

Does Medicare Advantage cover weight-loss surgery?

Yes, for a BMI of 35+ with a related condition. Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered. Medicare Advantage plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.

Does Medicaid cover weight-loss surgery?

Covered in most states with criteria. You need prior authorization, with paperwork from your doctor.

Is weight-loss surgery covered by insurance?

Gastric bypass, sleeve, and other bariatric surgery. Here’s how each kind of plan usually handles it.

Ask a specific question Plan a visit: cost and doctors Check it against my plan

Employer or MarketplaceCovered with conditions
Usually covered if you meet strict criteria: about 6 in 10 employers include weight-loss surgery.
More details
Plans that cover it usually require a BMI of 40 or more (or 35 or more with a condition such as diabetes, sleep apnea, or heart disease), a supervised program before surgery, and a psychological evaluation, with . Some plans exclude it, and Marketplace plans follow their state’s benchmark plan.
Cost: Inpatient surgery cost sharing: your deductible, then coinsurance up to your out-of-pocket maximum.
Original MedicareCovered with conditions
Yes, for a BMI of 35+ with a related condition.
More details
Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered.
Medicare AdvantageCovered with conditions
Yes, for a BMI of 35+ with a related condition.
More details
Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered. plans must cover this too, but set their own copays and often require providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions
Covered in most states with criteria.
More details
You need , with paperwork from your doctor.

Plan type	How it’s usually covered
Employer or MarketplaceCovered with conditions	Usually covered if you meet strict criteria: about 6 in 10 employers include weight-loss surgery. Plans that cover it usually require a BMI of 40 or more (or 35 or more with a condition such as diabetes, sleep apnea, or heart disease), a supervised program before surgery, and a psychological evaluation, with . Some plans exclude it, and Marketplace plans follow their state’s benchmark plan. Cost: Inpatient surgery cost sharing: your deductible, then coinsurance up to your out-of-pocket maximum.
Original MedicareCovered with conditions	Yes, for a BMI of 35+ with a related condition. Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered.
Medicare AdvantageCovered with conditions	Yes, for a BMI of 35+ with a related condition. Medicare covers gastric bypass and banding when medical treatment for obesity hasn’t worked. Your local Medicare contractor decides whether a sleeve is covered. plans must cover this too, but set their own copays and often require providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions	Covered in most states with criteria. You need , with paperwork from your doctor.

What usually has to be true

You must meet the plan’s rules for BMI and weight-related health problems.
A center of excellence may be required.

Good to know

Revision surgery has separate criteria.

Wegovy · Semaglutide for chronic weight management and heart risk reduction.
Nutrition counseling · Visits with a dietitian or counseling for weight and diet.

Sources

Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.

1
Essential health benefits
HealthCare.gov
Essential health benefits are ten categories of services, including ambulatory care, emergency services, hospitalization, maternity and newborn care, mental health and substance use services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive care, and pediatric services including oral and vision care.
2
Bariatric surgery
Medicare.gov
Medicare covers some bariatric procedures, such as gastric bypass and laparoscopic banding, for people with a BMI of 35 or more and at least one related condition who have been unsuccessful with medical treatment for obesity.
3
Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
4
Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.

General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.

Prior authorization: Commonly required
Typical total price: $15,000 to $35,000; per service, rough national range before insurance
Where to look in your SBC: Hospital stay facility fee; Hospital stay physician/surgeon fees
Pay with HSA or FSA: Eligible; Eligible when it treats obesity or another diagnosed disease.

What you’d likely pay

For weight-loss surgery, typically $15,000 to $35,000

Example: you might pay

$6,000

You $6,000Plan $19,000

$1,500 toward your deductible, plus $4,700 (20% of the rest).

Capped by your out-of-pocket maximum.

Based on a $25,000 bill, $1,500 left on your deductible and 20% coinsurance.

These are typical numbers, not your plan’s. Many plans charge a flat copay for visits instead. Use the numbers on your card or plan summary for a real estimate.

Was weight-loss surgery denied?Build an appeal with the right deadlines.

Is weight-loss surgery covered by insurance?

What usually has to be true

Good to know

Related

Sources