Are Weight Loss Programs Covered By Insurance?

When you go to a medical appointment, your provider likely asks you to step on the scale. Like other vital signs, your weight can help your doctor understand your overall health. Your body mass index—a measure of body fat based on your weight and height—isn’t a perfect measurement of your well-being. But high BMI, in some cases, is linked to heightened disease risk. 

As a result, your medical provider may recommend that you lose weight. Combining physical activity and a nutritious diet can help most people attain a healthy BMI. But in some cases, doctors recommend weight loss treatments, which your medical insurance may or may not cover. 

In this article, you’ll learn more about weight loss programs, whether they’re covered by insurance, and how to determine if your insurance covers weight loss treatments. 

Are Weight Loss Programs Covered By Insurance?

Given the impact of obesity on a person’s health, it makes sense for insurance to cover weight loss programs. Research suggests people with obesity and those who are overweight wish their insurance plans covered weight loss programs. Instead, insurers often pay for medical conditions related to obesity, such as diabetes or heart disease. 

The Affordable Care Act (ACA)—which includes commercial insurance—requires insurance providers to cover screening and counseling for obesity. But coverage for other treatments, medications, and procedures may be limited. 

Some insurance plans pay for these programs and treatments either partially or entirely, but most of the time, people end up paying out of pocket. Because every insurance company and plan is different, it’s important to contact your insurer to learn more about your benefits, including which weight loss programs may be covered. 

Does Insurance Cover Weight Loss Treatments?

There are many ways to lose weight, including diet and exercise. For people who struggle to maintain a healthy weight on their own, a doctor may recommend a medical route for weight loss.

Sometimes, your insurance may cover a portion of a weight loss program. Other times, insurance won’t pay anything. That’s why checking with your insurance provider before starting a program or treatment is crucial.

Below are some of the most common weight loss treatments, including whether insurance usually covers them. 

Weight Loss Programs

Weight loss programs, whether special diets or digital apps that help you manage your nutritional goals, can be valuable tools for people trying to lose weight. 

Generally, insurance doesn’t cover programs like this. Commercial insurers may sometimes reimburse or offer discounts for customers who participate in weight loss programs. Contact your insurer to learn more about potential benefits. 

Medicare and Medicaid do not provide benefits for weight loss programs. 

Counseling

Counseling, such as psychotherapy and nutritional counseling, can also help people lose weight. 

Most insurance providers, including Medicare and Medicaid, will pay at least partially for psychotherapy with an in-network therapy provider or dietary counseling with a medical provider. 

On the other hand, Medicare does not pay for nutrition counseling with a psychiatrist. Medicaid plans vary from state to state, and commercial insurance coverage varies by plan. 

Some people receive nutritional counseling from a dietitian. While some private insurance plans and Medicaid programs pay for this type of counseling, Medicare plans usually don’t—unless you’re receiving nutritional counseling for specific medical conditions, such as diabetes, hypertension, or kidney disease. 

Medication

More and more medications are being developed and approved by the Food and Drug Administration for weight loss. Examples include:

• Orlistat
• Contrave
• Saxenda
• Wegovy
• Ozempic
• Mounjaro
• Qsymia

Every insurance plan is different. Most Medicare plans are not required to cover weight loss drugs, and Medicaid plans vary by state. Commercial plans also vary in which weight loss drugs they cover, if at all.

Consult your insurance provider if you’re interested in a particular weight loss medication. In some cases, drug manufacturers offer discounts for people with insurance that won’t cover the drug. 

Surgery

Weight loss surgery, also called bariatric surgery, can help people lose weight by surgically changing the digestive system to help a person eat less or absorb fewer calories. It’s especially effective in people who have severe obesity. 

As long as a patient meets specific criteria—like having a certain BMI or a health condition related to obesity—many insurance plans cover bariatric surgery. 

For example, most commercial, Medicare, and Medicaid plans cover the two most common forms of weight loss surgery: gastric bypass and gastric sleeve. 

These insurance plans sometimes cover other weight loss surgeries, including the gastric band and duodenal switch procedures.

Most insurers require proof that a person has attempted to lose weight with diet and exercise alone to qualify for weight loss surgery. Most insurers also require people to have certain weight-related health conditions before paying for surgery.  

Because liposuction is seen as a cosmetic procedure, it’s usually never covered by any insurance plan. 

Devices

Lastly, medical devices that limit what you eat (or impact how your body absorbs calories and certain nutrients) can effectively manage your weight. Currently, the Food and Drug Administration (FDA) has approved four types of weight loss devices: 

• Intragastric balloons
• Gastric emptying systems
• Gastric bands
• Electrical stimulation devices

As with other weight loss treatments, devices are covered differently based on what type of insurance you have. It’s rare for Medicare and Medicaid to pay for these devices, and commercial insurance plans vary. 

If your insurer does pay for a particular device, it may require you to prove that other weight loss methods have yet to be successful. 

How To Know If Insurance Will Cover Weight Loss Treatments

If you have difficulty losing weight, speak with your doctor about the best way to shed pounds. Your provider can help you determine the options that will be safest and most effective for you. 

Once you land on a treatment, call your insurance provider or review your summary of benefits and coverage (SBC) to learn about what is and isn’t covered. That way, you can make an informed decision as you take steps toward improving your health. 

Bottom Line

While your BMI isn’t always an indicator of health, aiming for a healthy weight through exercise and a nutritious diet is always beneficial. 

If you need assistance with weight loss, speak with your medical provider for tips on achieving a healthy weight. Your provider may also recommend a weight loss treatment—such as a specific diet, counseling, medication, device, or surgery. 

If you have insurance, research before pursuing a particular weight loss treatment. Every treatment and insurance plan is different, and it’s important to be informed about your responsibility in the process. 

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