Happy New Year from Medicare Pathways! Let’s take a look at the most popular New Year’s Resolutions and how Medicare can help you follow through with your resolution! With a new year starting it is a good time to look back to the past, and more importantly, to the future and reflect on the changes we want, or need, to make and resolve to follow through on those changes.

Medicare Pathways has taken the most popular New Year’s Resolutions and researched each of them with original Medicare to determine if original Medicare will assist you in following through with your New Year’s Resolutions. The most popular New Year’s Resolutions dealt with becoming healthier and Medicare Pathways wants to support you in your New Year’s Resolutions. What better time to start than now! Additionally, based upon our research, you will have no excuses for not following through with each New Year’s Resolution. You will be surprised to learn the extent that original Medicare assists with helping you get healthy and stay healthy. We will look at each New Year’s Resolution and what original Medicare can do to assist you one at a time, beginning with the most popular.

Most popular New Year’s Resolution: Lose weight

Why is being over weight so unhealthy? In our looks obsessed society, lots of people think that being overweight is an appearance issue. Being overweight is actually a medical concern because it can seriously affect a person’s health. The health problems that stem from being overweight go way beyond the ones we usually hear about, like diabetes and heart disease. Being overweight can also affect a person’s joints, breathing, sleep, mood, and energy levels. So being overweight can impact a person’s entire quality of life.

Medicare has you covered if your New Year’s Resolution is to lose weight!

Under certain conditions Medicare will cover weight loss services and programs. Specifically, when weight loss is a necessary part of treatment for diseases such as hypothyroidism, Cushing’s disease, hypothalamic lesions, cardiovascular diseases, respiratory diseases, diabetes, and hypertension, as well as many other conditions, original Medicare will assist with weight loss programs. Medicare will also cover weight loss programs and services before surgery when the weight loss is necessary to reduce possible complications posed by obesity.

How do I qualify for weight loss help through original Medicare?

To qualify, you must be under the care of a doctor. The doctor must write a prescription, or an order, for the weight loss services and the need for the services must be documented in your medical records.

If you have Medicare Part C, or what is better known as a Medicare Advantage plan, you will need to call your plan and ask about qualifying for weight loss services. A Medicare Pathways Benefit Specialist can also help you review your Medicare Advantage plan to determine how to qualify for weight loss services. Your plan may offer additional services. Remember a Medicare Advantage Plan has to be as good as original Medicare, if not better, and cover the same services and sometimes additional services that original Medicare does not cover.

What does original Medicare cover regarding weight loss and how much will it cost?

Medicare will cover an initial assessment of your eating and activity habits, counseling on diet and physical activity, education on how to improve your diet and changes that will help you lose weight and improve your health, follow-up visits to monitor your diet and weight loss progress. Medicare will cover up to three hours of individual counseling services the first year, and two hours each year after that. If your condition or treatment needs changing, you may be able to receive more services. Your doctor must write a prescription, or order, for the additional services each year they are needed. You must receive the services from a qualified health professional that is Medicare-certified, or accepts Medicare assignment.

Your out-of pocket cost will depend on the type of Medicare plan you have. For example: Original Medicare Part B covers 80% of the approved amount for the service and you are responsible for the remaining 20%. However, if you have a have a Medicare Supplemental (also known as “Medigap”) plan, call to find out what is covered by the plan. Most likely with a Medicare Supplement plan you will pay little to nothing for qualifying weight loss services. If you have a Medicare Advantage plan, call the plan for information on coverage to determine if you will have to pay a co-pay and how much the co-pay will be. You may be surprised what your plan offers to help get you healthier and keep you healthy.

Talk to your doctor or health care provider about weight loss services. Your doctor or health care provider will be responsible for monitoring your program and documenting your progress, and will likely have an ongoing working relationship with local weight loss program providers or may even have them on staff.

So there you have it! If your New Year’s Resolution is to lose weight then you have no excuses for not following through. Contact your doctor and schedule your initial assessment so you can begin your New Year’s Resolution as soon as possible. It is important to remember not to start any weight loss program without consulting your physician first! Medicare Pathways wishes you success with your resolution and the start to a healthier and happier new year!


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