Does Insurance Cover Medical Weight Loss Programs?

According to various sources, over a third of Americans are considered to be overweight. Obesity is a real issue in the US and is partly responsible for many other medical conditions. 

These ailments can become very expensive for patients if they do not have health insurance. Medical expenses can be covered by your health insurance but you may be wondering if health insurance will cover medical weight loss programs. 

There are three primary treatments for obesity. These are weight loss surgery, medication, and counseling. But does insurance cover medical weight loss programs? Whether or not your health insurance covers these treatments is dependent on which state you live in and your insurance company.

How Does my State Affect My Health Insurance Cover?

Not all states cover the three recommended obesity treatments outlined above. In a lot of states, patients may be charged premiums on their insurance in order to cover some of these treatments. In other states, obesity treatments are limited to a subset of methods that are covered by a health insurance plan.

Having said this, coverage of obesity treatments by health insurance companies in different states appears to be changing for the better as far as patients are concerned. More states have recently adopted looser restrictions for the criteria that need to be met in order to qualify for obesity treatment via a health insurance plan. 

Alabama and North Carolina are two examples of states that have incentives for people to take health screenings. Other states like Georgia, Mississippi, and Virginia do not have strict rules regarding the criteria needed in order to qualify for obesity-related surgery. In Indiana, Michigan, and New Hampshire, these restrictions are more stringent.

Obesity screening is viewed as preventative health care which means it is covered by all health insurance due to the Affordable Care Act. If your body mass index exceeds 30, you will also be eligible for weight-loss counseling. Make sure to check on the type of coverage you are eligible for. Depending on your insurance, you may be entitled to slightly different things.

Does My Health Insurance Plan Cover Me?

Another factor that will affect whether or not you would be covered by a health insurance plan for obesity prevention treatments is your specific insurance plan. Some health insurance companies do cover weight loss treatments but each varies on the specific restrictions.

Many health insurance plans do not include weight loss surgery unless you are personally approved. The approval process depends on your meeting specific requirements in order to deem weight loss surgery as necessary. These can include meeting a set body mass index rating, having sleep apnea, coronary heart disease, or Type 2 diabetes.  In addition, patients may need to take part in a multidisciplinary surgical preparatory regimen in order to prove that they have already attempted to lose weight and have been unsuccessful in their efforts.

Other alternatives to health insurance policies are health savings accounts and flexible spending accounts. These allow you to keep money aside (free of tax) that can be used on medical expenses including the weight loss treatments mentioned in this article.

As long as a physician prescribes a weight loss program to deal with a particular medical condition. A diagnosis letter from a physician can also be used to obtain funds from a health savings account or flexible spending account to use on weight loss items such as fitness equipment, scales, pedometers, recipe books, and gym memberships.

Make sure to be fully aware of what your health insurance plan covers and does not cover. These can vary and will affect what weight loss programs you are eligible to receive under the plan.