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Bariatric surgery is the most effective intervention for achieving durable weight loss and improvement of comorbidities in patients with obesity. Limited data exist on the impact of Medicare status in patients undergoing Roux-en-Y gastric bypass. We hypothesized that there is no difference in outcomes between Medicare beneficiaries and non-Medicare patients at the 10-year follow-up.All patients who underwent Roux-en-Y gastric bypass with 10-year follow-up at a single medical center from 1985 to 2005 were stratified by Medicare insurance status. Outcomes included 10-year percent reduction in excess body mass index and comorbidity resolution.Of 617 patients who underwent Roux-en-Y gastric bypass with 10-year follow-up, 117 (19%) were insured under Medicare. Medicare patients were older (43 vs 40 years, P=.01) and had a greater preoperative body mass index (53.2 vs 51.0 kg/m2, P=.03) than non-Medicare patients, but there were no differences in preoperative median comorbidity index scores (3 [interquartile range 1–4] vs 2 [interquartile range 1–5], P=.33). At 10 years, weight loss (58.3% vs 57.0 percent reduction in excess body mass index, P=.16) and the decrease in median comorbidity index (1 [interquartile range 0–3] vs 1 [interquartile range 0–3], P=.85) were equivalent between groups.Roux-en-Y gastric bypass is equally beneficial in Medicare Disability and non-Medicare patients at 10 years. These findings support the continued and expanded coverage of bariatric surgery operations by Medicare.