Are weight loss treatments covered by insurance?

Insurance coverage for obesity treatment is available, but it can be limited. What obesity treatments does insurance cover? Is medical weight loss covered by insurance? That depends on the plan and the type of treatment.

As part of the Affordable Care Act (ACA), all marketplace health plans and many others must cover preventative obesity screening and counseling at no charge to you. That means you will not owe copays or deductibles or any other costs.

Medicare Part B covers obesity screenings and behavioral counseling if your body mass index (BMI) is 30 or more. BMI is a measure of body fat based on height and weight. To be covered, your primary care doctor or another qualified provider must offer the counseling in a primary care setting, such as a doctor's office.

You will not have to pay for these services, which include a dietary assessment and counseling that focuses on a diet and exercise regimen that will help you lose weight.

ACA health plans aren’t required to cover medications or surgeries used to treat obesity, although some do. Some states also have passed their own laws requiring coverage of various types of obesity treatments. For example, around two dozen states require individual, family and small group plans to cover bariatric surgery.

Health insurance plans that existed before the passage of the Affordable Care Act that have not been significantly changed don’t have to provide these services cost-free. Such plans are characterized as “grandfathered plans.”

In addition, some types of health insurance – such as short-term health plans – aren't required to offer these services.

Dr. Lloyd Stegemann, a member of the board of directors of the Obesity Action Coalition and the director of metabolic and bariatric surgery at Bay Area Hospital in Corpus Christi, Texas, wishes coverage of obesity drugs and surgery was more widespread. He believes the reluctance on the part of many insurance plans to cover these treatments grows out of the erroneous belief that poor personal behavior is the sole source of obesity.

“We have such a better understanding of what causes obesity today certainly than we did even 10 years ago,” he says. “And we know that this is not about fault, it’s about physiology. If we don’t control the physiology, we’re never going to get on top of this obesity epidemic.”

Are weight loss programs covered by insurance?

The National Conference of State Legislatures says 16 states require plans to cover some weight loss programs, including at least some coverage and reimbursement for:

  • Dietary or nutritional screening
  • Counseling and/or therapy for obesity, sometimes including weight loss programs

Another seven states require coverage for nutritional counseling or therapy, but only when the diagnosis or treatment is related to diabetes. 

The weight loss programs that are covered and the amount of coverage varies. Weight Watchers, for example, may be covered by some insurance, or the insurance company may offer a discount through a wellness benefit.

Does insurance cover weight loss pills?

Some health insurance companies cover obesity drugs, but other insurers balk at covering such medicines. Why doesn’t insurance cover weight loss drugs?

“Once you go on an obesity medication, you generally have to stay on it for life,“ Stegemann says. “And so it’s a cost concern for them.”

If your doctor prescribes medications for weight loss or obesity, contact your health insurance company to find out if it will cover them. You might find the information on your health insurer’s website. Or, you can learn more by calling a customer service representative and asking questions such as:

  • Which medications are covered and for how long?
  • Will I owe a copay?
  • Am I restricted to getting my medicines from specific pharmacies?

As a general rule, Medicare and Medicaid do not cover weight loss medications.

Will insurance cover Wegovy, Ozempic, or Mounjaro?

Semaglutides, sold under brand names like Wegovy, Ozempic, and a similar drug called Mounjaro, are gaining popularity for the treatment of obesity. Most insurance companies don't cover these drugs, which are actually diabetes treatments, for obesity, although there are some exceptions. Medicare and Medicaid will not cover it, as they don’t cover any weight loss prescription drugs.

Does insurance cover weight loss surgery?

Insurance coverage varies when it comes to weight loss surgery. Some health insurance companies don’t cover the cost of weight loss surgery. But, in other cases, an insurer will foot the bill as long as you meet certain conditions.

For example, the insurer may want you to have a full medical workup. You and your doctor likely will have to make a pre-authorization request for the surgery. The health insurance company also may not approve surgery until you have shown documented proof that you have undergone a physician-supervised weight loss program.

In addition, Stegemann says some insurers charge bariatric deductibles that are separate from the patient's regular deductible. Insurers also may place a cap on the amount of coverage they offer, with the patient on the hook for the remaining costs. Finally, you might have to wait up to a year while you try weight loss programs and counseling before the insurer will allow you to schedule the procedure.

Medicare covers some bariatric surgical procedures, including gastric bypass surgery and laparoscopic banding surgery. But to be approved, you have to meet conditions related to morbid obesity.

Medicaid covers weight loss surgery in most states.

Health insurance finder tool

Are you unemployed and lost your job within the past 60 days?
lady with box
Back
Can you get health insurance from your job?
Back
men use laptop
Back
Do you have spouse who can get health insurance through a job?
Back
couple
Back
What is your age?
Back
three mens
Back Reset result
Our recommendation

COBRA

Consolidated Omnibus Budget Reconciliation Act
People who lose their employer-sponsored health insurance may qualify for a COBRA plan. COBRA lets you keep your former employer's health plan, but you're responsible for paying all of the costs, including your former employer's portion.
Know more about COBRA
You can also opt for
Back Reset result
Our recommendation blue shield
Back Reset result

How much is your family income?

$1,000 $100,000

How big is your family?

Back
family
Back Reset result
Our recommendation

Medicare

People who are 65 and over qualify for Medicare. You can choose Original Medicare (also called Parts A and B), which is offered by the federal government, or Medicare Advantage (also called Part C), which private insurers provide. The average annual premium for Original Medicare is about $1,600. Medicare Advantage's average yearly premium is $336, but you may have higher out-of-pocket costs than Original Medicare.
Find out more about Medicare costs
Back Reset result
Our recommendation blue shield
family
Compare and Buy Health Insurance Quotes in minutes
Back Reset result
Our recommendation

Medicaid

Low-income Americans qualify for Medicaid. Thirty-eight states expanded Medicaid eligibility, so lower-middle-class Americans may also be eligible in those states. Medicaid offers comprehensive benefits, but at little to no cost depending on your income. Each state has its own eligibility. Some states are flexible with Medicaid eligibility for people who are pregnant, a parent or disabled. If your household income is below 138% of the federal poverty level, you're likely eligible for Medicaid if you live in a Medicaid expansion state. That level is $17,609 for an individual, $23,791 for a family of two, $29,974 for a family of three and $36,156 for a family of four. Non-Medicare expansion states have stricter income guidelines. Check with your state's Medicaid program to see if you qualify.
You can also opt for
Back Reset result
Our recommendation blue shield
family
Compare and Buy Health Insurance Quotes in minutes
Back Reset result
Our recommendation

Parent's employer-based health insurance

The Affordable Care Act lets children stay on a parent's health plan until the age of 26. Having a child on a parent's health plan may or may not increase premiums. It depends on whether you already have family coverage when adding the child to the plan. If a parent already has family coverage, adding a child won't likely increase premiums. However, going from single or couple to family coverage could cause premiums to skyrocket. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447.
You can also opt for
Back Reset result
Our recommendation blue shield
Back Reset result
Our recommendation

Spouse's employer-based health insurance

Most employers allow employees to add spouses to their health insurance. Going from single health coverage to a family plan may triple or quadruple your premiums. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447. Not all jobs allow for spouse's coverage, so you'll want to check with your employer to make sure it's an option.
You can also opt for
Back Reset result
Our recommendation blue shield
Find out more about
  • PPO
  • HMO
  • HDHP
  • EPO
Back Reset result
Our recommendation

Employer-based health insurance

Most people with private health insurance get their coverage through a job. employer-sponsored health insurance is usually cheaper than individual health insurance unless you qualify for Affordable Care Act subsidies. Job-based plans are generally less expensive because businesses often pick up more than half of employer-sponsored health insurance premiums. Kaiser Family Foundation estimates the average premiums for a single coverage employer-sponsored health plan is $1,186 and the average family plan is $5,447 annually.
You can also opt for
Back Reset result
Our recommendation blue shield
Click to each one of find out more
  • PPO
  • HMO
  • HDHP
  • EPO
Back Reset result
Employer plans are often one of these types of four plans. Click on each one to find out more.
  • PPO
  • HMO
  • HDHP
  • EPO

Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plans

Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
Find out more about the differences between plans

High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
Find out more about the differences between plans

Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
Find out more about the differences between plans
Back Reset result
green shield
family
Compare and Buy Health Insurance Quotes in minutes
Back Reset result
Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
Back Reset result
blue shield
To find the kind of ACA plan for you, would you rather...
Back Reset result
Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay lower premiums with a higher deductible may want the below plans
Back Reset result
silver shield

Silver is the second most popular plan in the ACA exchanges, with 35% of people with a Silver plan. Silver has lower premiums than any plan except for Bronze. However, it has lower out-of-pocket costs than Bronze. Silver plans pick up 70% of the costs, while members pay 30% The average single coverage in a Silver plan is $481 monthly and $1,179 for a family plan.

Bronze is the most popular type of plan in the ACA exchanges, with 41% of members with a Bronze plan. These plans have the lowest premiums, but also the highest out-of-pocket costs in the exchanges. Bronze plans pick up 60% of the costs, while members pay 40%. The average single coverage monthly cost in a Bronze plan is $440 and $1,080 for a family plan.

family
Compare and Buy Health Insurance Quotes in minutes
Back Reset result
Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay higher premiums with a lower deductible may want the below plans
Back Reset result
platinum shield

Platinum plans have the highest premiums but the lowest out-of-pocket costs. So, you pay more for the coverage initially but less than other plans when you need health care services. Platinum plans pick up 90% of the costs, while members pay 10%, Not many health insurers offer Platinum plans. Only 2% of members in ACA plans have a Platinum plan, so you may have trouble finding one. The average monthly premiums for single coverage in a Platinum plan is $706 and the average family coverage costs $1,460.

Gold plans have lower premiums than Platinum, but higher premiums than Silver and Bronze. Gold also has lower out-of-pocket costs than Silver and Bronze, but higher than Platinum. Gold plans pick up 80% of the costs, while members pay 20%. The average monthly premium for a single Gold plan is $596. Family coverage averages $1,426 per month.

family
Compare and Buy Health Insurance Quotes in minutes

How does obesity affect health insurance?

About 19% of children and 42% of adults are obese, according to the Centers for Disease Control and Prevention (CDC). Obesity has been tied to many health conditions, including:

  • Diabetes
  • Heart disease
  • Some types of cancer

All told, obesity costs the health system $147 billion a year, the CDC says.

A 2021 study by the Journal of Managed Care and Specialty Pharmacy found that the cost of medical care for adults with obesity compared to those at a healthy weight was 100% higher on average. For adults with class 3 obesity (BMI of 40 or higher) the increase in cost was 233.6%.

Given all these costs, can health insurance companies charge you higher premiums if you’re obese? Not under the ACA.

“Health insurance companies can't charge you more, but your employer can,” Stegemann says.

For instance, some companies will create a program that “basically taxes you for certain bad habits,” he says. You might pay more for health insurance if you’re a smoker or if you are obese.

FAQs

Are weight loss clinics covered by insurance?

Whether health insurance covers weight loss clinics depends on your specific plan and the reasons for seeking weight loss treatment. Some insurance plans cover weight loss programs if they are medically necessary, such as for treating obesity or related health issues like diabetes or heart disease. It's important to check with your insurance provider to see if they cover the specific weight loss clinic or program you're interested in.

Continue reading