Weight Loss and Health Care Reform: FAQ

Does health care reform cover obesity screenings and counseling?

Yes. All insurance plans, except grandfathered plans (see below) 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. The U.S. Preventive Services Task Force, which determines what preventive services plans must require, found obesity counseling was most effective when it was comprehensive and intensive. The number and type of sessions you receive will vary depending on your 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.

What are grandfathered plans?

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, are called grandfathered plans. Grandfathered plans don't have to offer free preventive care, including free obesity screening  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. They may include nutritional counseling, weight loss programs and weight loss surgery. Check on healthcare.gov or your state's Marketplace to find out.

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.

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How has health care reform affected wellness programs?

Many businesses offer programs to encourage people to adopt healthy habits, like losing weight or quitting smoking.

Some work wellness programs reward you for participating. Once you sign up, you might get money back for joining a gym or a weight loss program. Others offer rewards based on you meeting specific goals. You might get a financial reward, such as lower insurance costs, for stopping smoking or reaching a certain weight or blood pressure level.

The Affordable Care Act increases the amount of money that wellness programs can use to reward you for meeting specific goals. You could get up to a 30% discount on your health plan for meeting the goals of your wellness program, and up to 50% if you smoke and make progress toward quitting.

The rewards can be good incentives. However, some experts worry that they could wind up penalizing people who can’t meet their goals.

How does helping people control their weight affect heath care costs?

If you're overweight or obese, you know that losing some weight would be good for your health.

Insurance companies feel the same way. Helping people lose weight now could prevent a lot of health problems and high health care costs later. Obesity is associated with type 2 diabetes, cardiovascular problems, various types of cancer, and disability -- all of which increase the need for medical services and therefore, increase health care costs.

Obesity costs employers, too. Studies have linked obesity with lower productivity and more accidents. For these reasons, employers, health plans, and the government are trying different ways to help people lose weight.

 

 

WebMD Medical Reference Reviewed by Sarah Goodell on July 31, 2016

Sources

SOURCES:

American College of Sports Medicine: "How the Affordable Care Act Will Impact Business Wellness Programs."

Debbie L. Harrison, senior manager, public policy, National Business Group on Health.

Duke Health: "Insurance Carriers and Requirements."

HealthAffairs.org: "Implementing Health Reform: Workplace Wellness Programs."

Healthcare.gov: "What if I have a grandfathered health insurance plan?"

Federal Register: “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans."

Kaiser Health News: "AMA: Obesity is a Disease."

Ted Kyle, chairman, Advocacy Committee, Obesity Society.

National Business Group on Health: "Wellness Incentives."

National Heart Lung and Blood Institute: "Calculate Your Body Mass Index."

Obesity Society: "Obesity Treatments Under ACA."

Robert Wood Johnson Foundation: "Essential Health Benefits: 50-State Variations on a Theme."

Susan M. Pisano, vice president, communications, America's Health Insurance Plans.

Stop Obesity Alliance: "Weight Loss and the States."

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