If you need weight loss surgery but can’t afford it, you might want to explore government-funded programs, assistance for low-income patients, and free grants.
The government funds three types of insurance (Medicaid, Medicare, and ACA plans). Getting them to cover the majority of costs is the best way to get a gastric bypass or any other procedure for free or a nominal charge.
Low-income individuals might already have Medicaid or Medicare but could find ways to reduce costs further through a charity or a clinical trial.
Meanwhile, middle and upper-income patients paying taxes can reduce their out-of-pocket costs further via free grants from the IRS.
Government-Funded Weight Loss Surgery
Government-funded weight loss surgery might help you get a gastric bypass for free, or at least at a more manageable cost. Three pertinent insurance programs might approve claims and cover most expenses if your procedure is medically necessary.
- Prior participation in clinical weight loss program
- Body Mass Index (BMI) above 40
- BMI above 35 with obesity-related health problems
Medicaid could be a government-funded weight loss surgery program for low-income families and disabled individuals receiving Supplemental Security Income (SSI).
Medicaid covers some bariatric surgeries when medically necessary, meaning the government could pay for the majority (at least 80%) of your expenses. You might have no out-of-pocket costs, a nominal fee, or something more significant.
The federal government allows states to impose cost-sharing (copayment, coinsurance, deductibles, and other charges). However, this does not mean your plan includes these fees.
Verify these left-over charges with your Managed Care Organization (MCO) before your surgery so you are not surprised by a balance bill from the provider. Your household size and income relative to the Federal Poverty Level (FPL) determine the maximum out-of-pocket costs.
- Under 100% FPL: $75
- 150% FPL: 10% of the allowed amount
- 150% + FPL: 20% of what the agency pays
Medicare might be a government-funded weight loss program for seniors over 65 and former workers receiving Social Security Disability Insurance (SSDI).
Medicare covers some bariatric procedures when you meet specific conditions related to morbid obesity. The government could pay most (at least 80%) of your expenses.
Depending on your choices during the annual open enrollment for Medigap or Advantage plans, you might have no out-of-pocket costs, a nominal fee, or something more significant.
- Part A: covers in-patient surgeries partially
- $1,600 deductible
- 20% coinsurance
- Part B: covers out-patient operations with 20% coinsurance
- Supplemental (Medigap): pays its share of left-over expenses
- Medicare Advantage (Part C): leaves you with a small copayment
The Affordable Care Act (ACA) can act as a government-funded weight-loss surgery program for patients who make too much money to qualify for Medicaid or are too young for Medicare.
Apply for ACA insurance at healthcare.gov during open enrollment. Your new plan must cover pre-existing health conditions (morbid obesity) with no waiting periods for medically necessary treatment.
The government might provide two subsidies based on your household size and income relative to the Federal Poverty Level (FPL), which makes the cost of coverage and the procedure more affordable but not free.
- Premium tax credits reduce the upfront monthly cost of coverage for a silver-level plan, paying 70% of allowed charges (leaving you to cover 30%)
- Cost-sharing reductions lower deductibles, coinsurance, and copayments, limiting your out-of-pocket costs to 80% or 90% if qualified
Weight-Loss Surgery for Low-Income
Low-income patients finding financial help with weight loss surgery probably won’t get a gastric bypass for free, but they can reduce costs significantly.
Medicaid (adults) and Medicare (seniors) are the primary options for low-income earners. However, the impoverished might find alternatives if either program denies their claim or leaves them with unpaid balance bills (deductibles, copayments, or coinsurance).
Some charitable organizations provide financial assistance to low-income patients for weight loss surgery. However, because they rely on the generosity of donors, they can help just a few people every year.
The Weight Loss Surgery Foundation of America (WLSFA) has helped 28 people improve their health since 2010, or about one to two people annually. Unfortunately, we cannot find other charities with similar missions.
Clinical trials are another weight-loss surgery option for low-income families that need financial assistance because they cannot get Medicaid or Medicare to cover their procedure 100%.
Clinical trials recruit patients meeting narrow criteria who might be willing to undergo an experimental treatment. In exchange for acting as a test subject, the surgeons may provide pro bono services that do not require insurance.
Several online databases point potential clients to possible studies.
Free Weight Loss Surgery Grants
Weight loss surgery grants also won’t get you gastric bypass for free but could significantly reduce out-of-pocket costs for higher-income patients who pay taxes.
The government does not provide free grants to individuals but does offer three IRS-sanctioned ways for taxpayers to reduce expenses.
Choose between FSA, HSA, and Itemized Deductions based on whether your insurance agreed to cover your procedure. To illustrate the concepts, assume you are married, live in California, and have a $100,000 Adjusted Gross Income (AGI) as a family.
An IRS-endorsed Flexible Spending Account (FSA) acts as a free weight loss surgery grant best suited for the patients whose insurance covered the procedure, leaving them to pay the remaining 20% to 30%. An FSA includes a hidden financing option while saving you money on taxes.
Weight loss surgery financing for bad credit is guaranteed via your FSA. Choose the maximum annual contribution ($3,050 per employee) during the open enrollment and schedule the operation for the beginning of the plan year.
Your employer must immediately reimburse qualifying expenses, giving you up to 52 weeks to repay the loan with pretax money, reducing the tax bill of our example couple by almost 39%!
- Federal: 22%
- State: 9.3%
- FICA: 7.65%
An IRS-endorsed Health Savings Account (HSA) can be a free weight loss surgery grant, ideal for people who must self-pay because insurance does not cover the procedure. An HSA is a tax-favored funding vehicle attached to a high-deductible health plan (HDHP), which must be in place beforehand.
You can use an HSA to reimburse yourself for the prior year’s expenses, provided you continue with an HDHP. This rule allows you to overcome the annual contribution limit, generating savings regardless of the procedure prices.
- Self-only: $3,850
- Family: $7,750
- Age 55 or older catch up: $1,000 (additional amount per person)
For example, our California couple would generate 38.65% savings for each operation by reimbursing themselves in future years with pretax money.
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IRS Schedule A itemized deductions work as weight loss surgery grants best suited for people who must self-pay because insurance would not cover the procedure and those fearful of a high deductible health plan.
We list this option last because you do not avoid payroll taxes (FICA), and savings do not begin until you surpass two limiting thresholds.
- Itemized deductions must exceed the standard deduction
- Charitable Donations
- Mortgage Interest & PMI Premiums
- State & Local Property Taxes
- Casualty & Theft Losses
- Unreimbursed Medical & Dental Expenses
- Schedule A Medical & Dental Expenses must exceed 7.5% of Adjusted Gross Income (AGI)
For example, our California couple might generate the following 31.3% savings on their deductions above both thresholds, assuming they incurred $10,000 in property taxes and paid $5,000 in mortgage interest.
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