Medicare pays for Health Coaching

Can Medicare Help Me Lose Weight?

You may qualify for free counseling sessions to get rid of those extra pounds

by: Patricia Barry | from: AARP Bulletin | March 27, 2012

Q. I’m overweight and worried I could get diabetes. I’ve tried diets without much success. Can Medicare help me lose the pounds and keep them off?

A. Maybe. That depends on whether you tip the scales at the point where you would be considered not just overweight but obese. Medicare has just begun covering counseling sessions to help obese people lose weight. Shedding those extra pounds greatly reduces your risk of not only diabetes but also heart disease, high blood pressure, breathing problems and some cancers.
See also: Percent of obese adults in each state and D.C.

The new coverage means that, for the first time, Medicare will pay doctors to discuss weight problems with patients, advise them on diet and exercise, monitor progress and provide encouragement in regular visits. Patients enrolled in Medicare Part B pay no copays or deductible for these visits.

To qualify for free counseling, your body mass index — called BMI — must be 30 or higher — a score that currently applies to more than a third of Medicare beneficiaries, according to Medicare officials.

As a first step, you can use an online BMI calculator, such as the one provided by AARP. Enter your height and weight, and it instantly calculates your BMI number. In general, a BMI of 18.5 to 24.9 is considered normal; 25 to 29.9 is overweight; and 30 or higher is obese.
The Medicare counseling coverage includes:

• One session every week for the first month
• One session every other week for months 2 through 6
• Monthly sessions for a further six months (7 through 12) if you have lost at least 6.6 pounds by the sixth month.

If you don’t hit the required target of 6.6 pounds by the end of the first six months, you still get another shot. But you have to wait six months before Medicare will pay for you to try again, officials say. There is no limit to how many attempts you can make, provided that your body mass is still 30 or greater and that six months have gone by since the last attempt.
The counseling must be provided by a primary care doctor, nurse practitioner, clinical nurse specialist or physician assistant. Any of them can refer you to other facilities or specialists such as nutritionists, but you’ll have to pay for those. Medicare will cover only sessions that take place in a primary care setting.

If you’re interested in getting weight-loss counseling, remember that the coverage is so new that some doctors may not have heard about it. So you need to know that the program is officially called “Intensive Behavioral Therapy for Obesity,” and doctors should use billing code G0447 to submit to Medicare for reimbursement. If necessary, refer them to Medicare’s guidance for physicians on this topic.

Will doctors be able to help patients lose weight and keep it off?  A recent study by the Center for Weight and Eating Disorders at the University of Pennsylvania showed that such counseling can work well, even in sessions lasting only five to seven minutes. But researchers also found that the best results came over a two-year period of more intensive counseling by doctors who had received a few hours of special training. Research by the STOP Obesity Alliance found that 89 percent of doctors believed they had a responsibility to help their patients lose weight, but 72 percent also said they lacked the training to do it.

Still, obesity experts have welcomed the Medicare coverage as an important step in encouraging both doctors and patients to treat the issue seriously. 

Can Medicare Help You Quit Smoking?

Free counseling sessions are available for those trying to kick the habit

by: Patricia Barry | from: AARP Bulletin | November 17, 2011

Q. I am trying to quit smoking. Does Medicare have any programs to help me?

A. Yes. Medicare now offers free counseling sessions to help people kick the smoking habit.

Break that smoking habit before it damages your health. — Photo by Getty Images

In the past, Medicare has covered antismoking counseling only for those who have already developed health problems from tobacco use. These sessions require a 20 percent copayment and are subject to the annual Part B deductible.
But the new benefit at last puts the horse before the cart: It's for people who have no symptoms of tobacco-related diseases but want to quit smoking before it harms their health. And there's no copay or deductible for this counseling, provided that you see a doctor or other qualified practitioner who accepts the Medicare-approved payment as full reimbursement.
Among the 46 million Americans who smoke, about 5.5 million are Medicare beneficiaries, according to the Department of Health and Human Services. And a recent CDC study (PDF) found that more than 50 percent of smokers age 65 and older said they wanted to stop completely.

Tobacco use is the leading cause of preventable illness, responsible for an estimated one-fifth of deaths in the United States each year, and by 2015 it will have cost Medicare $800 billion over a 20-year period, according to an estimate by the Centers for Disease Control and Prevention.

The new coverage allows up to two "quit-smoking" attempts a year, and each attempt includes up to four counseling sessions — a total of eight in any 12-month period. So if you have the first session in March, for example, and the next seven sessions don't break your habit, you can start another attempt the following March and have up to seven more sessions over the next 11 months, and so on.

What happens in these sessions? Medicare officials haven't released specifics, but recommend that doctors follow the "5-A" approach formulated by the federal government 11 years ago: ask patients about their smoking habits; advise them to quit; assess their willingness to quit; assist their attempts to quit; and arrange follow-up.

To help the process, doctors also may prescribe one of seven antismoking drugs currently approved by the Food and Drug Administration. These medications are covered under the Medicare Part D drug program.

Research shows that either counseling or medications are effective in helping people to quit smoking. "But what is most effective is when you combine the two," says Michael C. Fiore, M.D., professor of medicine and director of the Center for Tobacco Research and Intervention at the University of Wisconsin. "That's why Medicare now covering counseling is so important."