Medicare covers screening and counseling for obesity

Decision adds a new preventive service for Medicare beneficiaries 

The Centers for Medicare & Medicaid Services (CMS) today announced that Medicare is adding coverage for preventive services to reduce obesity.  This adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act.  It complements the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next five years.

“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” said CMS Administrator Donald M. Berwick, MD.  “It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

 

Over 30% of both men and women in the Medicare population are estimated to be obese.  Obesity is directly or indirectly associated with many chronic diseases, including those that disproportionately affect racial and ethnic minorities such as cardiovascular disease and diabetes.  Addressing the prevention of obesity related disparities has the potential to reduce obesity prevalence while also closing the gap on health disparities among Medicare beneficiaries.

 

Screening for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians’ offices are covered under this new benefit.  For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m², the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months.  The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling.

 

“This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease,” said Patrick Conway, MD, MSc, CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards and Quality.  “We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.” 

 

Through the end of October, 22.6 million people with Original Medicare have received one or more of the free covered preventive services this year.

 

To read the final decision on the new national coverage determination, visit the CMS website at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253&

 

For more information about Million Hearts, please visit millionhearts.hhs.gov.