The majority of states have now expanded health insurance coverage to treat obesity, with some states specifically targeting diabetes in the measures they took to extend health coverage. This can result in some treatments and procedures, such as a gastric sleeve, being covered by insurers for patients suffering from severe obesity.
The Affordable Care Act (ACA) has a goal of making health coverage more uniform around the nation, as well as making health insurance plans cover a wider range of medical conditions. Starting in 2012, individual states were given the option to choose an existing health insurance plan to use as a benchmark.
This is why 33 states chose two coverage types in which obesity is recognized as a disease or let the U.S. Department of Health and Human Services establish a federal default. Due to these choices, many 2015 and 2016 policies now recognize obesity as a medical condition and also provide coverage for issues related to diabetes. Treatment options now covered include:
Bariatric Surgery
In 23 states, health benefits must include coverage for bariatric surgery, commonly referred to as gastric bypass surgery. This surgical procedure helps fight the urge to over-eat by reducing the physical size of a patient’s stomach. Prior to the passage of the Affordable Care Act, only five states had the mandate to provide coverage for morbid obesity or to offer coverage as an option. In addition to the 23 states with a health benefits requirement, three states (Georgia, Indiana and Virginia) have decided that coverage for morbid obesity must be offered in at least some policies available to patients without requiring that it be included in all health insurance policies.
Nutritional Counseling and Therapy
As of now, some form of coverage for dietary or nutritional screening measures, including certain programs aimed to encourage weight loss, is provided in 16 states. Seven more states mandate such coverage, however, it is limited to patients who were diagnosed with diabetes or who require treatment related to this condition.
A few additional changes to the ACA taking effect as of 2014 address cost-sharing by consumers and surcharges to premiums related to obesity.
No Consumer Cost-Sharing Under Insurance Plans
The majority of insurance plans in all states now have to cover some services without requiring cost-sharing by the consumer. These services include screening for and counseling for obesity-related issues in adults and children. In some states, bariatric surgery procedures such as installing a gastric sleeve fall under this requirement. The restriction on consumer cost-sharing means that no annual deductibles, coinsurance or copayments can be applied to specified health services.
Premium Surcharges
Previously, it wasn’t uncommon for health insurance providers to charge higher premiums to patients who are overweight or suffering from morbid obesity. After the changes to the ACA that went into effect as of 2014, all forms of premium surcharges on enrollees for being obese are banned in the majority of insurance policies everywhere in the nation. This prohibition on premium surcharges also extends to policies sold through exchanges.
