Anyway around Medicare's 5yr rule?

I have medicare and I read that they require you be 35 + for 5yrs and prove ypu have tried other things like nutrisystem etc   well my weight keeps goibg higher and higher and my health keeps gettibg worse. Are there anyways around this?  What about getting a insurance add on like Aetna or BCBS?  Help!!!!!

First, you list your BMI as 31 - so it doesn't appear you would qualify for any WLS.  But you should contact Medicare directly and get the information straight from them.  Then, proceed from there.

I too have medicare and a secondary with CSI.  I have had a high BMI for years so I do not know about the 5 yr rule but I know that Medicare paid for my surgery and has treated me quite well.  And if you are trying other diet plans to qualifybe careful what you choose...double check wiht medicare...I do know that Weigh****chers does not count...it has to be medically supervised.  Hang in there!

I too have medicare and a secondary with CSI.  I have had a high BMI for years so I do not know about the 5 yr rule but I know that Medicare paid for my surgery and has treated me quite well.  And if you are trying other diet plans to qualifybe careful what you choose...double check wiht medicare...I do know that Weigh****chers does not count...it has to be medically supervised.  Hang in there!

Medicare itself DOES NOT have a 5 year rule. That MIGHT be a condition of a Medicare Advantage policy or a State Medicaid policy, but NOT Medicare:

Your insurance companies may state different requirements for bariatric surgery. The reason is that for insurance plans offered by employers, it depends on what the employer is willing to include in their offering to you, the employee. Medicare has these standards: (notice, they may differ from what you read in your employee health insurance packet).

Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R)
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) ≥ 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. There is a separate Decision Memo that adds the Vertical Sleeve.

The requirement to use a COE by Medicare has been rescinded

Effective for dates of service on and after September 24, 2013, CMS no longer requires that covered bariatric surgery procedures be performed in facilities that are certified. CMS will continue to update this webpage with facility certification information prior to September 24, 2013.

That means that for those having surgery thru Medicare or Medicaid no longer have to use a COE (Center of Excellence).

FAILED ATTEMPTS does not mean 5 years of a 35+ BMI. I floated between 34 and 36 most of my adult life but could not document the five previous years of a BMI over 35. Medicare STILL paid for my surgery.

Thank you for the info. I have just straight medicare through SS. Where do I start or do u recommend where I should start?  I need help to get this weight off and lower the levels of opiates and muscle relaxers I am on. 

Start by verifying your BMI with your primary care doctor. If it's below a 35, Medicare will not pay. Between 35 and 40 you will require a significant comorbid such as diabetes, sleep apnea to name two. 

Good luck.

I have Medicare and haven't heard of a 5 year rule but I do know that they want you to do a 6 month medically supervised weight loss plan and they don't consider Nutri systmen, weigh****cher, jenny craige etc to count towards them or at least they didn't for me and I have done them all. All I can say is good luck. Also they don't pre-approve for surgery either. I was told that I would have to sign papers saying I will pay if they don't but in the same conversation I was also told they never had it come back saying they wouldn't pay after surgery. I don't like this but it is what it is. Good Luck I couldn't really get much information from the insurance company I got all my information from the weight loss clinic and they deal with them all the time. 

Thank you so much