Does Health Insurance Cover Weight-Loss Treatments?

The weight of the average American has been a concern for several years. The Center of Disease Control (CDC) estimates over 70 percent of American adults are overweight. On top of that, over 36 percent are obese.

Unfortunately, many American children are overweight as well. The CDC estimates almost 10 percent of children in the two- to five-year-old age range are obese. About 20 percent of children between the ages of 6 to 11 are obese and over 20 percent of children between the ages of 12-19 are also obese.

These staggering numbers prove to show why many Americans seek treatment for their weight.  200,000 Americans have bariatric surgery every year, and many more take medication, try nutritional planning, or counseling to lose weight.

All of these options come with a heavy price tag, as bariatric surgery can cost up to $30,000. Fortunately, there are some health insurance options that can help.

Why Health Insurance Covers Weight Loss Treatments

Being overweight or obese can be very expensive simply because of the conditions that can come with it. Overweight or obese adults are more likely to suffer from heart disease, diabetes, cancer, and high blood pressure, which those treatments can be costly over time.

When you add together the cost of the collective weight-related problems that can occur, the total is immense. The Havard T.H. Chan School of Public Health put the cost at $190 billion in 2005 for obesity-related conditions. The U.S. National Library of Medicine estimates that obesity raises annual medical costs by $2741 in 2005. Because of the high costs, insurance companies are willing to help cover the cost of weight loss treatments, as it can help lead the patient to a healthier lifestyle.

The majority of health plans cover some, if not all, of the weight-loss treatments you or your family may need. Currently, all personal, family and small business plans cover basic obesity screening. It also requires those plans to pay for nutritional counseling for those who qualify. Be sure to check with your provider to see what they can help cover.

There have been great improvements in health coverage for obesity. Before the Affordable Care Act, only five states required insurers to cover bariatric or gastric bypass surgery. Today, there are now 23 states.

What about Medicare and Medicaid?

As with many private health plans, Medicare Part B also covers weight lost counseling sessions. However, the counseling must be in a doctor’s office or another primary care setting. Patients must have a body mass index (BMI) of 30 or higher as well to qualify.

In order to not have to pay the bill on your own, make sure your care provider accepts assignment before you schedule your first session. Medicare covers some weight-loss surgeries such as gastric bypass and lap band procedures. I can’t really pinpoint how fully Medicare will cover such surgeries due to variables linked with the procedures.

Before you have such an operation, you should:

1. Ask your doctor or hospital how much you’ll have to pay for the surgery and after-care.
2. Ask if it’s an inpatient or outpatient procedure.
3. Review any supplement health insurance you may have to see if it will cover this weight loss program.
4. Look over your Medicare plan to see what’s covered. Calling your Medicare representative for guidance and assistance would be beneficial.

You should also check your most recent “Medicare Summary Notice” to see if you’ve met your deductible. If you’re admitted to the hospital for the surgery, check your Part A deductible. If it’s an outpatient procedure, focus on the Part B deductible. Either way, you have to meet your deductible before Medicare will cover this type of cost. You may have copayments afterward.

Medicare, Medicare Part D in particular, is not required to cover weight-loss medications. Some do anyway, so it doesn’t hurt to check your coverage. If you have Medicare Advantage, Medigap, or Medsup, then your chances are better.

Medicaid can cover counseling as well. The range of coverage differs from state to state, so check your with your state’s Medicaid site to learn more.

I hope that you can get on the right path toward a healthy life and investigate how your insurance company can cover the cost of a weight loss program.

Honestly yours,
Alice

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