Weight Loss and Health Care Reform: FAQ
Does health care reform cover obesity screenings and counseling?
Yes. Any insurance plan you can buy in your state's Marketplace includes a free obesity screening test. Your health care provider will use your weight and height to find your body mass index, called your BMI. A BMI of 25 or higher is overweight. A BMI of 30 or more is obese.
If you get the screening test and are obese, you'll qualify for free counseling to help you lose weight. You'll get between 12 to 26 sessions.
The type of counseling differs depending on the plan. Some people might get one-on-one counseling in person or on the phone. Others might get counseling in a group or through existing programs, such as Weight Watchers.
Check your plan's summary of benefits to see the details on what's offered.
Can I get the free screening test and counseling if I get insurance through my job?
In most cases. Most employer health plans have to cover obesity screening tests and counseling. Some older plans that were already in place when the Affordable Care Act became law on March 23, 2010, and that haven’t made many changes to their benefits, called grandfathered plans, don't have to offer free screening tests or counseling.
Will health plans I buy from my state's Marketplace cover treatment, like weight loss programs, medications, or surgery?
That depends on the state. Each state has to cover certain essential benefits, but they get to decide what's included in them. Some states include obesity treatments in their essential benefits. Some don't.
For instance, in Massachusetts, all plans sold in the state Marketplace must cover weight loss programs and surgery for obesity. But in Arkansas, plans that don't cover either can still be sold in the Arkansas Marketplace. To learn more about what's available in your state, see WebMD's state map.
Will the insurance I get through work cover weight loss treatments?
That depends on your insurance. Keep in mind that even if your plan does cover surgery, you'll have to meet specific requirements. Plans have different rules.
For instance, you may have to have a BMI of 40 or higher to qualify. Or you may be able to qualify if you have a related condition -- such as diabetes -- and a BMI of 35 or above.
You and your doctor may need to show your health plan that you tried other ways to lose weight for at least 6 months in order for the plan to help pay the cost of surgery.