Per ACA Regulations, Most States Have Expanded Health Insurance Coverage For Obesity Treatments

Since 2012, the Affordable Care Act has allowed states to select pre-existing insurance plans as the statewide “benchmark” in order to support better and more uniform health plans. However, in many cases the coverage is limited to medically-recognized diseases, which led to a process of defining what could and couldn’t be covered under ACA plans. Over the last few years, obesity has been added to the list of medically recognized conditions, and two types of coverage for diagnosis and treatment of obesity were put in place. As a result of these additions, most policies from 2015 onward will now cover two types of treatment:

1.Bariatric Surgery

Twenty-three separate states now require plans to cover bariatric surgery, which is performed to reduce the physical size of a patient’s stomach and thus their overall appetite. This includes both gastric bypass and surgery and gastric sleeve surgery, among a few other procedures. Before the ACA, obesity was only mandated to be covered in five states, but now there are twenty-three states where patients can receive gastric sleeve procedures or other surgeries. There are also three states–Georgia, Indiana and Virginia–where coverage must be offered in some policies, but is not required for all policies.

2.Nutritional Counseling/Nutritional Therapy

Sixteen states currently offer at least some degree of coverage and reimbursement for all nutritional screenings, therapy or counseling for those living with obesity. Sometimes, the coverage is even extended to cover weight-loss programs. Aside from this, there are seven states that cover nutritional counseling or therapy only for diagnoses or treatments related to diabetes.

Aside from the coverage for these obesity treatments, as of January 1st of 2014, the ACA has required the following additions to policy:

-No more consumer cost-sharing is allowed for some services. Most insurance plans across the country are now required to cover certain services without cost-sharing. These include obesity screenings, counseling and other therapeutic services for both adults and children. As part of this regulation, the coverage will include no annual deductible, as well as no enrollee copayments or any types of coinsurance.

-For most insurance policies, premium surcharges for being diagnosed as obese are now prohibited. This includes plans sold through exchanges, and these regulations apply to all fifty states.

Thus far, changes in ACA legislature have steadily increased required coverage for obesity-related diagnoses and treatments, spelling good news for those seeking help paying for treatments. However, it is important to note that changes in legislature vary greatly from state to state. While more than half of the fifty states now list obesity as a medically-recognized disease, and require coverage for diagnosis, counseling and bariatric surgery at a minimum, many states still offer little to no coverage for obesity-related treatments and procedures. In addition, many states offer coverage but with limitations, or certain conditions that must be met.

But since 2014, the ACA has instituted reforms that apply to nearly all insurance plans, most notably the regulations on consumer cost-sharing and the elimination of premium surcharges for obesity. If changes in legislature continue in this direction, patients with obesity can expect coverage from more states as well an increase in additional regulations and benefits.