- Are weight loss treatments covered by insurance?
- Does insurance cover weight loss drugs?
- Does insurance cover weight loss surgery?
- What weight loss programs are covered by insurance?
- Which insurance plans cover weight loss treatment?
- Can you use HSA or FSA funds to pay for weight loss?
- FAQ: Weight loss and insurance
Are weight loss treatments covered by insurance?
Insurance coverage for obesity treatment is available, but it can be limited. Coverage depends in the type of treatment.
GLP-1 drugs. Although coverage for GLP-1 drugs like Ozempic, a diabetes drug that has been prescribed off-label (prescribed for a condition different from what the drug is labeled or approved for), has been limited, things are changing. Drugs like Wegovy and Zepbound, which are approved specifically for weight loss, are more likely to be covered.
Other prescription weight loss. Other drugs approved for treatment of obesity, such as Qysemia and Contrave, may be covered by insurance, but again, it depends on the plan.
Weight loss surgery. Gastric bypass and other weight loss surgeries may be covered, but generally require that you meet specific requirements and get pre-authorization.
Weight loss programs. Insurance generally doesn't cover weight loss programs like Noom, but may provide some coverage for behavioral therapy and nutritional counseling.
Does insurance cover weight loss drugs?
Some health insurance companies cover obesity drugs, but coverage varies depending on the type of drug.
“Once you go on an obesity medication, you generally have to stay on it for life,“ 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, 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?
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.
What weight loss programs are covered by insurance?
Some weight loss plans, or at least some portion of those plans, may be 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.
Which insurance plans cover weight loss treatment?
Insurance plans are not required to cover weight loss treatment, so coverage varies by plan. Here's a look at what you can expect from common plans.
ACA marketplace plans
ACA health plans aren’t required to cover medications or surgeries used to treat obesity, although some do. Some states have also passed laws requiring coverage for various types of obesity treatments. For example, around two dozen states require individual, family and small group plans to cover bariatric surgery.
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
Medicare does not cover weight loss drugs, including GLP-1s, but does cover some weight loss surgeries if deemed medically necessary.
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.
Individual and group health insurance plans
Coverage for weight loss drugs, surgeries and treatments on private and group health insurance plans vary widely.
Some will cover GLP-1s with prior authorization, and others don't cover them at all. The same applies to other treatments. You can, however, expect to have some coverage for obesity screenings and nutrition or counseling services.
Dr. Stegemann 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.”
Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong. Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.
ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.
Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.Health insurance finder tool
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Employer-sponsored health insurance
Preferred-provider Organization (PPOs)
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 plansHealth maintenance organization (HMO)
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 plansHigh-deductible health plans (HDHPs)
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 plansExclusive provider organization (EPO)
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
Learn more about individual insurance plans
Know more individual insurance / ACA 
Know more individual insurance / ACA 
Can you use HSA or FSA funds to pay for weight loss?
You can use funds from your health savings account (HSA) or flexible spending account (FSA) to pay for approved weight loss treatments, including:
- Prescription drugs
- Medical weight loss programs, like Weigh Watchers
- Weight loss surgery
- Medical services like a nutritionist or therapist
You can't use HSA or FSA funds for:
- Non-prescription medications or supplements
- Gym memberships
- Exercise equipment
- Diet foods or meal replacements
You may be able to use a wellness credit, if available from your employer, for gym memberships and exercise equipment.
FAQ: Weight loss and insurance
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.
