Medicare beneficiaries can now receive co-payment–free screening and counseling for obesity under a new benefit created through the Affordable Care Act.
On Nov. 29, officials at the Centers for Medicare and Medicaid Services announced that they had added intensive behavioral therapy for obesity as a preventive service to be offered to Medicare beneficiaries without cost sharing, effective immediately.
In a memo on the decision, CMS noted that the scientific evidence was adequate to conclude that behavioral therapy in individuals with a body mass index of 30 kg/m2 or greater was "reasonable and necessary" to prevent illness or disability.
The benefit includes screening for obesity by measuring body mass index, conducting a dietary assessment, and providing counseling and therapy to promote sustained weight loss. Medicare will cover counseling with a primary care physician or other primary care provider. The coverage includes one face-to-face visit every week for the first month and one face-to-face visit every other week for months 2 though 6. At the 6-month visit, the provider must assess whether the effort is resulting in weight loss. Patients must have lost at least 3 kg (about 6.6 pounds) in the first 6 months to qualify for an additional 6 months of visits.
More than 30% of people over age 65 are estimated to be obese, according to a CMS press release.
"This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease," Dr. Patrick Conway, CMS chief medical officer, said in a statement. "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."
The obesity screening and counseling benefit is being added to a list of preventive services covered by Medicare without beneficiary cost sharing. That list includes an annual well visit; tobacco cessation counseling; certain immunizations; and screening for bone density, cervical cancer, cholesterol, colorectal cancer, diabetes, breast cancer, HIV, and prostate cancer.