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Key takeaways
Coverage for obesity treatment varies by state, insurance plan, and type of treatment, often excluding weight management therapy and certain medications unless specific conditions are met.
Insurance companies may cover the costs of obesity-related complications but are inconsistent in covering treatments aimed at weight loss, such as prescription medications and surgeries.
Some weight-loss programs and medical devices might be partially covered by insurance, Medicare, or Medicaid, depending on the individual’s specific plan and state regulations.
Patients seeking obesity treatment should consult with their healthcare provider and insurance company to understand their coverage, explore all treatment options, and potentially access savings through various programs.
As part of every annual checkup, your healthcare provider measures your height and weight. These two numbers are used to calculate your body mass index (BMI), a measure that gauges if you’re at a healthy weight. Under 18.5 is underweight, 18.5 to 24.9 is normal, 25 to 29.9 is overweight, and 30 or higher is obese. BMI numbers aren’t perfect—they don’t account for lean muscle mass, for example—but they are a helpful guideline for your health.
Obesity is linked to different health problems—such as diabetes, hypertension, hyperlipidemia, heart attack, stroke, various cancers, and even early-onset arthritis. “And then we have the mental health aspects of increased risk of depression, anxiety, suicidal ideation, and substance abuse,” says Delene Musielak, MD, founder and host of The Dr. Mom Show.
In other words, it’s hard on your body, and your mind. If you’re trying to lose weight for health reasons, insurance coverage for obesity treatment can add another complicated factor.
What obesity treatments does insurance cover?
Obesity affects more than a third of Americans. The frustrating thing about health insurance is that coverage typically pays for the complications of obesity (like diabetes and heart disease care) but not for treatments to help offset the extra pounds causing health issues. If your weight is affecting your health, treatments can include weight management therapy, prescription medication, surgery, or medical devices like an intragastric balloon. Unfortunately, coverage for obesity care is pretty inconsistent.
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“There’s this perception that, if they offer coverage as a health insurance provider, everyone who needs it is going to show up tomorrow and want this care and it’s going to be really expensive,” says Joe Nadglowski, CEO of the Obesity Action Coalition. “So they put all these barriers in front of people. They put higher copays. You have to fail at all these other programs first before you can access some of these therapies. So even if there is coverage, it’s very rarely easy.”
These charts offer a brief overview of which weight loss procedures and programs are covered by insurance, and which aren’t. Every plan and state is different, so regardless of what’s listed below, you’ll want to check with your provider—even if it’s Medicare or Medicaid obesity coverage.
Weight-loss programs
Some insurance companies are starting to offer incentives for their members to get fit and stay at a healthy weight by offering discounts or reimbursements on weight-loss programs. Typically, coverage varies by state and insurance provider, so if you have a particular diet plan in mind, don’t hesitate to call your insurance company.
| Weight-loss programs covered by insurance | ||||
|---|---|---|---|---|
| Program | Covered by insurance? | Covered by Medicare? | Covered by Medicaid? | Considerations |
| Weight Watchers | Some insurance plans offer discounts or reimbursements for the cost of weight loss programs if they achieve results. | No | No | You may have to pay for the program up front, then show proof of results before getting reimbursed. |
| Nutrisystem | No | No | ||
| Silver sneakers | Yes | No | Plans that cover this type of program may have additional costs. |
Counseling
There are several types of weight management therapy offered. These programs help you identify and fix unhealthy patterns—with the guidance of a physician, dietitian, or mental health professional. These programs may include an eating plan, exercise plan, or even help setting realistic goals. Only counseling with your primary care provider is covered by most insurance plans.
| Weight management therapy covered by insurance | ||||
|---|---|---|---|---|
| Treatment | Covered by insurance? | Covered by Medicare? | Covered by Medicaid? | Considerations |
| Physician-led counseling | Yes | Yes | Yes | |
| Dietitian-led counseling | Varies by state and insurance provider | No. | Varies by state | Covered if done by a primary care physician. Medicare Part B will sometimes cover medical nutritional therapy if you’ve had certain conditions like diabetes, kidney disease, or kidney transplant within 36 months. |
| Psychiatrist-led counseling | Varies by state and insurance provider | No | Varies by state | Covered if done by a primary care physician. |
Medication
When combined with lifestyle changes, prescription medications can help manage weight in people with a BMI of 30 or greater or those with a BMI of 27 or greater with obesity-related health conditions. Obesity medications work in different ways—some preventing your body from absorbing fat from food, others by decreasing appetite. Some, but not all insurance plans cover medications that treat obesity, according to the National Institutes of Health. If your treatment is not covered, a SingleCare coupon could help you save on the cash price of the medication.
| Weight-loss drugs covered by insurance | ||||
|---|---|---|---|---|
| Treatment | Covered by insurance? | Covered by Medicare? | Covered by Medicaid? | Considerations |
| Alli or Xenical (orlistat) | Varies by state and insurance provider | Prohibited under Part D as “weight-loss” drugs | Varies by state; few cover these drugs | Not recommended for use during pregnancy. |
| Adipex, Lomaira, or Suprenza (phentermine) | Short-term use only. Not recommended for use during pregnancy. | |||
| Wegovy (semaglutide) | Given weekly by injection. May increase risk of pancreatitis. | |||
| Contrave (naltrexone-bupropion) | Not recommended for use during pregnancy. | |||
| Qsymia (phentermine-topiramate) | Not recommended for use during pregnancy. | |||
| Saxenda (liraglutide injection) | Not recommended for use during pregnancy. |
RELATED: Compare Contrave vs. phentermine
Surgery
Bariatric surgery involves making physical changes to your digestive system that limit how much you can eat or reduce absorption of calories and certain nutrients. It’s used if diet and exercise have proven ineffective or you have a health problem related to your weight. But does insurance cover weight-loss surgery? These surgeries can be very expensive, but they may be covered by insurance if you meet certain criteria.
| Weight-loss procedures covered by insurance | ||||
|---|---|---|---|---|
| Treatment | Covered by insurance? | Covered by Medicare? | Covered by Medicaid? | Considerations |
| Gastric bypass | Yes | Yes | Covered in most states | Must have a BMI >40 or 35-40 with comorbidities. Patients cannot have an endocrine cause of obesity. Must have failed at other weight loss attempts. |
| Gastric sleeve | Yes | Yes | Covered in most states | Must have a BMI >40 or 35-40 with comorbidities. Patients cannot have an endocrine cause of obesity. Must have failed at other weight loss attempts. |
| Duodenal switch | Varies by state and insurance provider | Yes | Covered in most states | Must have a BM I>40 or 35-40 with comorbidities. Patients cannot have an endocrine cause of obesity. Must have failed at other weight loss attempts. |
| Gastric band | Varies by state and insurance provider | Yes | Covered in most states | Must have a BMI >40 or 30-40 with comorbidities. Patients cannot have an endocrine cause of obesity. Must have failed at other weight loss attempts. |
| Liposuction | No | No | No | This is considered cosmetic surgery. |
Devices
Medical devices can also be used to limit what you eat, and how your body absorbs it. There are four types approved by the FDA: intragastric balloons, gastric bands, gastric emptying systems, and electrical stimulation devices. Additionally, the weight management pill, Plenity, is considered a medical device that expands in your stomach, which limits how much you can eat. If your insurance company provides coverage for a medical device, often they will require documentation that shows other weight-loss treatments have been attempted first.
| Weight-loss devices covered by insurance | ||||
|---|---|---|---|---|
| Treatment | Covered by Insurance? | Covered by Medicare? | Covered by Medicaid? | Considerations |
| Intragastric balloon | Varies by state and insurance provider | Varies by state; few cover these devices | Varies by state; few cover these devices | Must be an adult and have a BMI of 30-40. |
| Gastric bands | Varies by state and insurance provider | Varies by state; few cover these devices | Varies by state; few cover these devices | |
| AspireAssist (gastric emptying system) | Varies by state and insurance provider | Varies by state; few cover these devices | Varies by state; few cover these devices | Must have a BMI of 35-55. Must have failed at other weight loss attempts. |
| Plenity | Varies by state and insurance provider | Varies by state; few cover these devices | Varies by state; few cover these devices |
How to find out about your coverage
The very first thing you should do if you’re seeking obesity treatment is have a conversation with your healthcare provider. Learn about your BMI, any comorbidities, and any medical issues in your family history. Try to get a full picture of your overall health, so you know how to move forward. “Being proactive is the best path to prevention,” Dr. Musielak says.
Plus, you’ll need all this information to determine if you need to see a specialist or can work with your primary care physician to treat obesity—which will have an effect on insurance coverage for obesity treatment.
After you have a full picture of your health, take that information back to your insurance company and ask what’s covered and what’s not. Your healthcare provider may give you specific insurance billing codes for various treatments. Ask your insurance provider under what criteria coverage would apply. Don’t assume you don’t have coverage.
Keep in mind, as well, that it can be difficult to find obesity care coverage in your insurance plan. It could show up in employee assistance programs, it could be in wellness coverage, it could be somewhere else. “When [companies] have this coverage all over the place, people can’t find it,” Nadglowski says. Reach out to your benefits administrator for assistance.
If one type of treatment isn’t covered, another one might be. Explore all of your options. Most private insurance and Medicare plans partially cover drugs for conditions that can contribute to weight gain, such as diabetes and hypothyroidism. If Wegovy for weight loss isn’t covered by your insurance, Ozempic for diabetes may be covered instead—these two Rx have the same active ingredient. Remember, too, that you can find savings on treatments in other ways. SingleCare offers savings on medications, and you can sometimes apply for additional savings through Medicare, Medicaid, and patient assistance programs. You may also be able to take advantage of a self-pay discount, through which a hospital may offer discounts to cash-paying patients. Even though getting coverage for weight-loss treatments is a little trickier than getting coverage for other health issues, there are ways to make the weight-loss treatment you need affordable.
