Weight Loss and Health Care Reform: FAQ
I've gotten many email asking about the changes in our healthcare policies next year and a quick answer is that it will depend on your state. Now, having said that, I found an article of interest. The Q & A in the following article may answer some of your questions about the changes in your health insurance policy next year and if your trying to lose weight your insurance may help you with the doctor or counselor.
Does health care reform cover obesity screenings and counseling?
Yes. Starting in January 2014, any insurance plan you can buy in your state’s Marketplace includes a free obesity screening test. Your health care provider will use your weight and height to find your body mass index, called your BMI. A BMI of 25 or higher is overweight. A BMI of 30 or more is obese.
If you get the screening test and are obese, you'll qualify for free counseling to help you lose weight. You'll get between 12 to 26 sessions.
The type of counseling differs depending on the plan. Some people might get one-on-counseling in person or on the phone. Others might get counseling in a group or through existing programs, like Weight Watchers.
Check your plan's summary of benefits to see the details on what's offered.
Can I get the free screening test and counseling if I get insurance through my job?
In most cases. Starting in January 2014, most employer health plans have to cover obesity screening tests and counseling. Some older plans that were already in place when the Affordable Care Act became law on March 23, 2010, and that haven’t made many changes to their benefits, called grandfathered plans, don't have to offer free screening tests or counseling.
Will health plans I buy from my state's Marketplace cover weight loss treatment, like programs, medications, or surgery?
That depends on the state. Each state has to cover certain essential benefits, but they get to decide what's included in them. Some states include obesity treatments in their essential benefits. Some don't.
For instance, in Massachusetts all plans sold in the state Marketplace must cover weight loss programs and surgery for obesity. But in Arkansas, plans that don't cover either can still be sold in the Arkansas Marketplace. You can check your state by going online at your state Marketplace or your state’s website.
Will the insurance I get through work cover weight loss treatments?
That depends on your insurance. Keep in mind that even if your plan does cover surgery, you'll have to meet specific requirements. Plans have different rules.
For instance, you may have to have a BMI of 40 or higher to qualify. Or you may be able to qualify if you have a related condition, like diabetes and a BMI of 35 or above.
You and your doctor may need to show your health plan that you tried other ways to lose weight for at least 6 months in order for the plan to help pay the cost of surgery.
How has health care reform affected wellness programs?
Many businesses offer programs to encourage people to adopt healthy habits, like losing weight or quitting smoking.
Some work wellness programs reward you for participating. Once you sign up, you might get money back for joining a gym or a weight loss program. Others offer rewards based on your meeting specific goals. You might get a reward for exercising a certain amount or reaching a certain weight or blood pressure level.The Affordable Care Act increases the amount of money that wellness programs can use to reward you for meeting specific goals. In 2014, you can get up to a 30% discount on your health plan for meeting the goals of your wellness program. The rewards can be good incentives. However, some experts worry that they could wind up penalizing people who can’t meet their goals.
How does helping people control their weight affect heath care costs?
If you're overweight or obese, you know that losing some weight would be good for your health. Insurance companies feel the same way. Helping people lose weight now could prevent a lot of health problems and high health care costs later. Obesity costs employers, too. Studies have linked obesity with lower productivity and more accidents. For many reasons, employers, health plans, and the government are trying different ways to help people lose weight.
Does health care reform cover obesity screenings and counseling?
Yes. Starting in January 2014, any insurance plan you can buy in your state’s Marketplace includes a free obesity screening test. Your health care provider will use your weight and height to find your body mass index, called your BMI. A BMI of 25 or higher is overweight. A BMI of 30 or more is obese.
If you get the screening test and are obese, you'll qualify for free counseling to help you lose weight. You'll get between 12 to 26 sessions.
The type of counseling differs depending on the plan. Some people might get one-on-counseling in person or on the phone. Others might get counseling in a group or through existing programs, like Weight Watchers.
Check your plan's summary of benefits to see the details on what's offered.
Can I get the free screening test and counseling if I get insurance through my job?
In most cases. Starting in January 2014, most employer health plans have to cover obesity screening tests and counseling. Some older plans that were already in place when the Affordable Care Act became law on March 23, 2010, and that haven’t made many changes to their benefits, called grandfathered plans, don't have to offer free screening tests or counseling.
Will health plans I buy from my state's Marketplace cover weight loss treatment, like programs, medications, or surgery?
That depends on the state. Each state has to cover certain essential benefits, but they get to decide what's included in them. Some states include obesity treatments in their essential benefits. Some don't.
For instance, in Massachusetts all plans sold in the state Marketplace must cover weight loss programs and surgery for obesity. But in Arkansas, plans that don't cover either can still be sold in the Arkansas Marketplace. You can check your state by going online at your state Marketplace or your state’s website.
Will the insurance I get through work cover weight loss treatments?
That depends on your insurance. Keep in mind that even if your plan does cover surgery, you'll have to meet specific requirements. Plans have different rules.
For instance, you may have to have a BMI of 40 or higher to qualify. Or you may be able to qualify if you have a related condition, like diabetes and a BMI of 35 or above.
You and your doctor may need to show your health plan that you tried other ways to lose weight for at least 6 months in order for the plan to help pay the cost of surgery.
How has health care reform affected wellness programs?
Many businesses offer programs to encourage people to adopt healthy habits, like losing weight or quitting smoking.
Some work wellness programs reward you for participating. Once you sign up, you might get money back for joining a gym or a weight loss program. Others offer rewards based on your meeting specific goals. You might get a reward for exercising a certain amount or reaching a certain weight or blood pressure level.The Affordable Care Act increases the amount of money that wellness programs can use to reward you for meeting specific goals. In 2014, you can get up to a 30% discount on your health plan for meeting the goals of your wellness program. The rewards can be good incentives. However, some experts worry that they could wind up penalizing people who can’t meet their goals.
How does helping people control their weight affect heath care costs?
If you're overweight or obese, you know that losing some weight would be good for your health. Insurance companies feel the same way. Helping people lose weight now could prevent a lot of health problems and high health care costs later. Obesity costs employers, too. Studies have linked obesity with lower productivity and more accidents. For many reasons, employers, health plans, and the government are trying different ways to help people lose weight.
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