Creator: SingleCare
Published: 2022-01-10T09:30:17-05:00

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.

“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.

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.