Health Insurance and Weight-Loss Treatment
The weight of the average American is a serious issue these days. The Center of Disease Control (CDC) figures over 70 percent of American adults are overweight. On top of that, over 36 percent are obese.
A lot of 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. Just under 20 percent of kids ages six to 11 are obese, and just over 20 percent of the 12 to 19-year-old range are as well.
When you look at these numbers, you can see why many Americans explore medical options to lose weight. 200,000 Americans have bariatric surgery every year. Many more take medication, try nutritional planning, and counseling in order to lose weight.
All of these options come with a heavy price tag. Bariatric surgery can cost up to $30,000. Prescription meds and counseling is not cheap either. Fortunately, there are some health insurance options that can help. Read on to find out which ones do and what they cover.
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.
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. The U.S. National Library of Medicine estimates that obesity raises annual medical costs by $2741 in 2005. As such, these costs can be more than the average American budget can handle on its own.
Weight-Loss Surgery and Counseling
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 to cover basic obesity screening. It also requires those plans to pay for nutritional counseling for those who qualify.
There are great improvements in health coverage for obesity now. Before the ACA, only five states required insurers to cover bariatric or gastric bypass surgery. That number is now up to 23 states.
Many larger health insurance plans cover weight-loss treatments and services as well. For example:
Aetna covers many weight-loss surgeries. There may be approval needed if you have an HMO or QPOS.
Cigna covers many of the same. However, there may be some exclusions for bariatric surgery. Review your policy or talk to your agent to be sure.
Kaiser Permanente covers gastric bypass and gastric sleeve surgery if you meet their criteria.
If your health plan covers one type of weight-loss surgery, it’s a safe bet that it will cover most or all of them.
Health Insurance and Weight-Loss Medication
In general, health insurance is more likely to cover weight-loss surgery than weight-loss medication. The FDA has approved the major weight-loss medications, however health insurers are reluctant to cover them. One reason for this may be the sketchy past of the diet-drug industry. In the late 1990’s, evidence showed that the diet suppressant Fen-Phen damaged heart valves. It was then pulled from the market.
Another reason may be that people who are on a weight-loss medication regimen may need it all their lives. Given that weight-loss drugs can cost up to $200 a month, that’s too much for most insurers to take on. As a result, most Americans have to pay for weight-loss medications out of pocket.
Medicare and Weight-Loss
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 other primary care setting. Patients must have a 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. We can’t really pinpoint how fully Medicare will such surgeries due to variables linked with the procedures.
Before you have such an operation, you should:
- Ask your doctor or hospital how much you’ll have to pay for the surgery and after-care.
- Ask if it’s an inpatient or outpatient procedure.
- Review any supplement health insurance you may have to see if it will cover surgery.
- Look over your Medicare plan to see what’s covered. Calling you Medicare rep isn’t a bad idea either.
You should also check your most recent “Medicare Summary Notice” to see if you’ve met your deductibles. 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 afterwards.
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 and Weight-Loss Treatments and Services
Medicaid can cover weight-loss surgery and counseling as well. The range of coverage differs from state to state, so check your with your state’s Medicaid site to learn more.
Medicaid covers bariatric surgery in 48 states now. However, you should be aware that only a few states cover all obesity treatments. Also, a number of states allow insurers to limit coverage of obesity-linked conditions.
Again, check with your state’s Medicaid agency for specific coverage.