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Deb Gordon

Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of Umbra Health Advocacy, a marketplace for patient advocacy services, and co-director of the Alliance of Professional Health Advocates, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government. Deb previously spent more than two decades in healthcare leadership roles, including chief marketing officer for a Massachusetts health plan and CEO of a health technology company. Deb is an Aspen Institute Health Innovators Fellow, an Eisenhower Fellow and a Boston Business Journal 40-under-40 honoree. Her contributions have appeared in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, The Hill and Managed Care Magazine. She earned a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.

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Does Your Health Insurance Cover Treatment for Obesity?

Obesity is a disease but not all treatments are covered

Created With Support
obesity

Designed by Elizabeth Gething

Infographic on Obesity and Health Insurance

The American Medical Association recognized obesity as a disease in 2013, but it can still be hard to get treatment. Access to obesity care, such as medications and behavioral therapy, depends on your health insurance.

The Affordable Care Act (ACA) requires most health plans to cover obesity screening and counseling at no cost. But not every plan covers every obesity treatment.

If you get health insurance through:

An employer or a union

Check your plan documents or talk to your benefits administrator about what is covered.

A health insurance marketplace (sometimes called Obamacare)

Health plans available on Healthcare.gov must meet the minimum ACA requirements for obesity treatment coverage, but some states require insurers to cover more. See your state’s rules on obesity care coverage.

Medicaid

You may be eligible for free or low-cost obesity treatment. Out of 51 state Medicaid programs (including Washington, D.C.):

  • 41 cover obesity counseling
  • 20 cover nutrition counseling
  • 16 cover anti-obesity medications
  • 49 cover at least one type of surgery for the treatment of obesity

To find out what Medicaid covers in your state, contact your state Medicaid agency.

A state employee health plan

Out of 51 state employee health insurance programs (including Washington, D.C.):

  • 51 cover obesity counseling
  • 42 cover nutritional counseling
  • 23 cover anti-obesity medications
  • 43 cover at least one type of surgery for the treatment of obesity

Check out the Stop Obesity Alliance (STOP) to find out what’s covered in your state.

Medicare

For people with a body mass index (BMI) of 30 or higher, Medicare covers:

  • Obesity screening
  • A nutritional evaluation
  • Behavioral counseling

For people with a BMI of 35 or higher, Medicare covers some weight-loss surgery if you meet certain conditions.

Medicare does not cover:

  • Consultations with a nutritionist
  • Anti-obesity medications
  • Cosmetic surgery

If the treatment you need isn’t covered:

Appeal to your insurance plan. Your healthcare provider can help by arguing that these services are vital to your health and will save the insurer money over time.

For tips about how to support the Treat and Reduce Obesity Act (TROA), a proposed law to increase coverage for obesity treatments, visit the Obesity Care Advocacy Network.

This resource was created with support from Novo Nordisk.

 

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