Obesity is defined as having a body mass index (BMI) of 30 or higher. It is a growing public health concern, affecting an estimated 42.4% of adults in the United States.

Obesity is associated with increased risk of numerous chronic conditions, including heart disease, diabetes, and certain types of cancer. As a result, many individuals with obesity may require medical treatment and ongoing care, which can lead to significant healthcare costs.

Understanding your health insurance policy’s coverage for obesity-related services can help you manage these costs and ensure you receive the care you need.

How Obesity Affects Insurance Coverage

Individuals with obesity may be at greater risk for certain health conditions and may require more frequent medical care than those who are not obese.

As a result, insurance companies may view individuals with obesity as higher-risk patients and may charge higher premiums or deductibles. In some cases, insurance companies may also exclude coverage for certain obesity-related services or treatments.

Coverage for Obesity Screening and Counseling

Under the Affordable Care Act, most health insurance plans are required to cover obesity screening and counseling at no cost to patients.

This means that insurance companies must cover the cost of a screening test to determine whether an individual has obesity and provide counseling to help individuals with obesity manage their weight and reduce their risk of obesity-related health problems.

Coverage for Obesity Treatment

In addition to screening and counseling, some insurance plans may cover other obesity treatments, such as bariatric surgery, weight loss medications, and nutrition or exercise programs.

Bariatric Surgery

Bariatric surgery is a weight loss surgery that is used to help patients who are severely obese lose weight.

Depending on the insurance plan, bariatric surgery may be covered, but there are usually specific criteria that must be met in order for the surgery to be considered medically necessary. These criteria typically include a certain BMI, a history of failed attempts at weight loss through other methods, and certain obesity-related health conditions.

Weight Loss Medications

Some insurance plans may cover FDA-approved weight loss medications, but coverage may vary depending on the medication and the individual’s specific situation.

Some medications may only be covered if they are prescribed by a doctor or if the individual has certain obesity-related health conditions.

Nutrition or Exercise Programs

Insurance plans may also cover nutrition and exercise programs for individuals with obesity.

These programs may be offered through the insurance company or through a healthcare provider and may include services like nutritional counseling, exercise classes, or personalized weight loss plans. Coverage for these programs may vary depending on the individual’s plan and the specific program being offered.

Understanding Your Coverage

It is important to understand your health insurance policy’s coverage for obesity-related services and treatments.

If you are unsure about your coverage, it is recommended that you speak with your insurance provider or healthcare provider for more information.

When reviewing your policy, be sure to look for any exclusions or limitations on coverage for obesity-related services or treatments.

You should also review your plan’s deductible, copay, and coinsurance amounts, as these can significantly impact your out-of-pocket costs for medical care.

Conclusion

Obesity is a serious public health concern that can lead to significant healthcare costs.

Understanding your health insurance policy’s coverage for obesity-related services and treatments can help you manage these costs and ensure that you receive the care you need. Be sure to review your policy carefully and speak with your insurance provider or healthcare provider for more information.