Does Medicare Cover Obesity Screening and Behavioral Therapy?

Gaining a little weight as we age isn’t uncommon. Many of the factors that can keep us slimmer become more difficult as our metabolism slows, our endurance shortens, and we get settled. For most people, this isn’t a cause for alarm — it just comes with life and aging. Being overweight isn’t inherently a bad thing and becoming comfortable in and accepting of your body is a healthy mindset to have. There are even some circumstances where your doctor may suggest you gain a little weight.

Despite the body-positive message that we feel is important to share, there are some health benefits of attaining and maintaining a healthy weight, though you should work with your doctor to find what a healthy weight is for you. If you are at a weight where you doctor is suggesting you should lose some weight, there’s a good chance you’ve tried to lose weight before. You’ll also likely be familiar with how difficult it can be. If you do find yourself needing help, there are methods that have been shown to be effective, and Medicare may be able to help you take advantage of these services.

What is Intensive Behavioral Therapy for Obesity?

One of the more tried and true methods for healthy weight loss is intensive behavioral therapy for obesity, sometimes called obesity behavioral therapy. Instead of focusing on a medical or surgical solution to obesity, intensive behavioral therapy works to change your unhealthy habits into healthier ones, thus leading to weight loss. The beauty of this program is that it can be incredibly adaptable to each individual undergoing it. This can make it more effective than a one-size-fits-all style program, since it aims at making changes to the lifestyle habits that are unhealthy for you. Instead of just having you exercise more, intensive behavioral therapy looks at your life, pinpoints that unhealthy habits, like snacking or portion size or being sedentary, and helps you make a healthy change.

Some of the strategies used to encourage healthier habits can include having you track your eating habits, follow an exercise plan, or even change your environment to promote less snacking, to name only a few. In some cases, self-help groups or weight-loss programs may be included in the overall therapy if your doctor feels that it’s necessary. You’ll also be challenged to set realistic goals for yourself, so you have a target to aim for, depending largely on you and your capabilities.

Does It Work?

Unsurprisingly, obesity behavioral therapy has been shown to be effective when tested in studies. One study ran a year-long analysis of 150 adults in three different groups, one in intensive behavioral therapy alone, one with an anti-diabetic and obesity medication, and a third with therapy, the medication, and a calorie restrictive diet. All three groups saw weight loss, with the last two groups seeing the most weight loss. This does show that intensive behavioral therapy is a non-drug option for those seeking to lose weight.

Similar results were found in another study that looked at the efficacy of intensive behavioral therapy for obesity when compared to different types of meetings. The study found that even 10- to 15-minute behavioral counseling meetings held with one’s doctor every month or quarter can help with weight loss, though this was even more effective when adapted with other therapeutic methods. Long-term studies have found that, while many experienced weight loss in the short-term, ongoing contact was necessary to preserve the weight loss and health benefits. This illustrates the difficulty of sustained weight loss and the importance of both body positivity and behavioral therapy for obesity. Furthermore, it shows why something like obesity behavioral therapy can be effective at keeping the weight off in the long term.

Does Medicare Cover It?

The question of whether intensive behavioral therapy works perhaps got the best support when, in 2011, the Centers for Medicare & Medicaid Services (CMS) released a decision memo announcing Medicare’s coverage of the therapy. Included in the memo was a definition of what intensive behavioral therapy for obesity, a specific 5-A framework for therapy programs, an outline of coverage, and requirements for coverage. For a Medicare beneficiary to qualify for Medicare Part B coverage for obesity behavioral therapy (as identified on the Medicare.gov site), you must have a body mass index (BMI) of 30 or more (labeled as obesity class I and up).

Should you qualify for coverage, Medicare will cover the initial screening for your BMI at the doctor’s office, as well as the behavioral therapy sessions. These sessions can include dietary assessments and counseling. With Medicare’s coverage, you would pay nothing for these services as long as your doctor or the qualified practitioner accepts Medicare assignment. Under the framework specified for intensive behavioral therapy for obesity by CMS, your doctor should:

1. Assess: Assess behavioral health risks and what may influencing your goals and desire to change.
2. Advise: Give clear, specific, and personalized suggestions on how to change this behavior, like benefits of health risks of those behaviors.
3. Agree: Based on your interest and willingness to change, create therapy goals and methods to reach those goals.
4. Assist: Act as a guide for you in reaching the agreed goals by gaining skills, confidence, and support structures, and medical treatment if necessary.
5. Arrange: Provide ongoing support with follow ups and adjustments to the treatment plan as needed.

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Intensive behavioral therapy for obesity is a highly personalized and adaptive therapy for those looking to lose weight. Without resorting to clichés, it’s important to be comfortable and accepting of the body you have and to maintain a healthy body image, but there may come a time when you need to lose some weight for your health. If your doctor suggests that you lose some weight and you qualify for coverage, this therapeutic option may work for you.