As for Medicare, its Part D prescription drug benefit doesn't cover any anti-obesity medication. Only 6% of people with marketplace plans have it available to them without restrictions. Your plan might require you to meet certain conditions, such as having obesity plus another health issue. Some health insurance plans offer discounts or reimbursement for fitness programs or gym memberships, but this is typically not a standard benefit. Additionally, some plans may have limitations on the duration of coverage or the amount of medication you can receive. For example, if you have a doctor’s referral and a BMI of 30 or higher, your insurance may cover weight loss surgery or a comprehensive weight loss program. Many weight loss clinics and surgeons offer financing options, such as loans or payment plans, to help make treatment more affordable. Many insurance plans cover these programs, making them a viable alternative for those seeking assistance. Insurance companies may reject coverage if they believe the weight loss drug is not medically necessary. Look for sections that discuss prescription medication coverage, specifically those detailing weight management drugs. Most insurers will require documentation from a healthcare provider demonstrating that the drug is medically necessary for the patient’s weight management and overall health. It’s important to understand the insurance requirements to qualify for bariatric surgery coverage so you can plan and take the right steps. For many insurance plans, certain rules must be followed before coverage is approved. Keeping a detailed weight and health history, working closely with a healthcare provider, and using the right medical language are key steps. A letter of medical necessity from a healthcare provider may be required, especially if the expense is questioned by the IRS or a plan administrator. Even with partial coverage, total costs can still be high, especially for people with high deductibles or high coinsurance rates. The authors therefore concluded that PHEN/TPM CR, in conjunction with lifestyle modification, may provide a well-tolerated and effective option for the sustained treatment of obesity complicated by cardiometabolic disease. Although in this trial lorcaserin facilitated sustained weight loss without a higher rate of major cardiovascular events than that with placebo, the FDA reviewed that data and concluded that the potential risks of lorcaserin outweigh its benefits. Nowadays, medicinal plants and natural treatments are becoming more and more popular. Pharmacologic treatment of exogenous obesity should be adjunctive to caloric restriction, increased physical activity, and behavioral modification. This treatment works well for skin texture improvement and moderate laxity on the face and body. “Sofwave is a non-invasive form of treatment. Several proven technologies can tighten loose skin without surgery. However, if you have significant laxity and your weight has been stable for several months, there is no reason to wait longer before exploring your options. If you are young, lost weight gradually, and have good skin elasticity, your skin may tighten somewhat on its own over one to two years. A growing range of these drugs – including major names such as Wegovy, Zepbound and Mounjaro – is already disrupting the weight loss industry. Today, GLP-1, as it is more commonly known, is a household name, after drugs that mimic its effect were found to be remarkably effective in aiding weight loss. If your patients have Medicare Part D or Medicare Advantage prescription coverage, encourage them to reach out to their plan to determine coverage and next steps. The Centers for Medicare & Medicaid Services may cover Wegovy® for certain patients, such as adults with cardiovascular disease and either obesity or overweight. You additionally agree that you will not submit the cost of any portion of the product dispensed pursuant to this offer to a federal or state healthcare program for purposes of counting it toward your out-of-pocket expenses. What types of weight loss programs are typically covered by insurance? No weight loss plateau was observed during the 6-month GLOW study, and weight loss was sustained during a 24-week follow-up period.Dr. B-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Dr. B telehealth platform.Procedures like gastric bypass or sleeve gastrectomy can result in significant weight loss.This hormone helps control blood sugar, slows digestion, and helps people feel full sooner and for a longer time.They need to document your weight loss journey and provide evidence of medical necessity.Multivariable logistic regression was conducted to analyze whether differences in respondents’ beliefs existed by weight category (overweight vs obese) or by health insurance type.Medicare doesn’t cover prescription weight-management medications, but some Medigap and Medicare Advantage plans do. However, the landscape of insurance coverage for these medications is complex and often confusing. Most insurance companies recognize that people who are overweight and obese are more likely to get serious health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea. But when you have a lot of weight to lose, and if exercise, medications, and diet aren't enough, you might consider weight loss surgery, also called bariatric surgery. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations. Although there is not a generic version of Ozempic on the market, there are alternative medications for managing Type 2 diabetes. You can obtain some medications at no cost through the Novo Nordisk Patient Assistance Program, if you qualify. Contact your state's Medicaid agency for details about your plan and whether Ozempic is covered. Congress prohibited the program from covering obesity treatments as part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). Novo Nordisk, the manufacturer of Ozempic, has an online tool to help determine the cost of Ozempic with your insurance plan. Obesity transcends the superficial concerns of body image, embedding itself deeply as a chronic condition with far-reaching health implications. With the right knowledge and strategies, the journey toward a healthier you becomes not just a possibility, but a reality. The complexity of insurance policies turns what should be a straightforward step into a labyrinthine challenge, leaving individuals feeling lost and frustrated. Additionally, the study population is restricted to those individuals who reported having a primary care visit in the past year, so findings are not generalizable to those individuals who lack access to health care or choose not to see a physician. If your insurance doesn’t cover weight loss surgery, there are still options available. It’s also a good idea to talk to your doctor or a weight loss surgery center to get a better understanding of the coverage and requirements. Look for any sections related to weight loss or bariatric surgery to see if it’s mentioned as a covered service. To check if your insurance covers weight loss surgery, you should start by reviewing your insurance policy documents or website. However, coverage for weight loss programs varies widely across different policies and providers. Those who hope to see insurance coverage for weight loss drugs will have to continue to contend with the expensive price tag for the foreseeable future. This policy would have gone into effect in 2026 if the Trump administration had backed the change; however, CMS recently announced that it has decided against covering these medications for weight loss under Medicare and Medicaid prescription drug coverage. North Carolina and New Mexico cover weight loss drugs in their plans. Approximately 50 million adults in the U.S. have insurance coverage for anti-obesity medications. The average cost of bariatric surgery is between $7,400 and $33,000 before insurance coverage. Check with your private or employer insurance provider to find out the details of your plan’s coverage. Medicaid coverage for weight-loss medications varies depending on the state in which you reside. Medicare is prohibited from covering weight-loss medications unless they are prescribed for other health reasons. Check your plan to find out whether these medications are covered and, if so, which ones are approved. The Two Main Categories of Weight Loss Programs An 80/20 split for coinsurance rates is common, which means you would be responsible for paying 20% of the cost of your surgery. This portion is often dictated by the coinsurance rates you agreed to before you enrolled in your health insurance plan. When you can see the specifics of your plan at a glance, you can spend less time managing your plan and more time accessing the healthcare services you need. For certain individuals, weight loss surgery may be a practical and effective option for losing weight quickly. If you don’t have insurance or Medicaid coverage, there are resources that may be able to help you pay for PrEP and/or your necessary clinic visits and tests. Consult with your healthcare provider today to discuss your options and create a personalized weight loss plan. It’s essential to understand your insurance policy, consult with your healthcare provider, and meet clinical criteria to increase your chances of getting coverage. However, weight loss medication is not considered an essential health benefit, and coverage is not guaranteed. Coverage varies by state, and individuals should check with their Medicaid provider to see if weight loss medication is covered. If wellness benefits, and premium discounts tied to these benefits, are to be successfully used to promote weight loss, it will be important for health plans to offer benefits that overweight adults find helpful and to conduct outreach to ensure that enrollees can access wellness benefits. This study provides a national snapshot of overweight and obese individuals’ perceptions of insurance coverage of weight loss–related benefits on the cusp of implementation of provisions of the ACA that promote such benefits. Although large, private employers commonly offer wellness benefits through their health plans,8 public insurers have been less likely to offer wellness benefits for weight loss.16 This state of affairs may change as provisions of the Affordable Care Act (ACA) promote wellness benefits. For individuals struggling with severe obesity (typically classified as having a BMI over 40), bariatric surgery may be a viable option.If you don't have pre-existing conditions, a medical exam is usually not required.Some companies choose to include obesity care in their employee health plans, while others do not.If you have questions about what is covered under your policy, please contact us for clarification.All participants were enrolled in a 4-session US Air Force ‘Sensible Weigh’ group weight control program.You may be wondering, “What’s this going to cost me?Additionally, some insurers may require patients to participate in a medically supervised weight loss program for a set period before considering surgical options.Then, discuss with your provider what additional information may help. If the out-of-pocket costs for these weight loss drugs are too expensive for your budget, you are not alone. Oral weight-loss medications are less commonly known but are designed to help control your appetite and assist in developing healthier eating habits. These drugs also reshape the way healthcare professionals and the public perceive obesity, a condition historically viewed as a problem of willpower. Certain medications are only FDA approved to treat conditions other than weight but may be prescribed to help aid in weight loss. What you pay for Zepbound depends on your insurance coverage and any savings programs you join. Another barrier to coverage has been the perception of weight-loss medications. If you have Medicare, you’re probably wondering if your weight-loss medications will be covered. Many people are turning to medications such as Ozempic (semaglutide), Wegovy (semaglutide), and Zepbound (tirzepatide) to aid with weight loss. So, what should patients do in the meantime if their insurer is dropping coverage of weight loss drugs? In some cases, medication may be prescribed for a short period, such as several months, to help jumpstart your weight loss journey. In fact, combining medication with lifestyle changes can help you achieve more sustainable and significant weight loss. It’s essential to work closely with your healthcare provider to monitor your progress and manage any side effects that may arise. They will work with you to develop a personalized treatment plan that takes into account your unique needs and health goals. For example, your insurance provider might require you to try lifestyle changes, such as diet and exercise, for a certain period before approving medication. If your insurance claim is denied, appeal the decision and provide additional documentation to support your claim. Health outcomes are better for all diseases when treatment options are Tell the individual how obesity and its related conditions have affected you and your family. Understanding what insurance companies usually want can improve the chances of getting the treatment covered. People with Medicare can talk with their doctor to see if their health history might qualify them for coverage under a diabetes diagnosis. This includes Wegovy and other GLP-1 medications when used for obesity without diabetes. Monthly Cost Comparison New cardiovascular outcomes and long-term safety evidence may accelerate coverage changes. Another clinician reframed a Medicare beneficiary’s treatment as primarily for glycemic control and submitted guideline-relevant documentation; the plan reversed an initial denial. That difference can affect prior authorization criteria and copay structure, so discuss administration route with your clinician as part of the treatment plan. Human clinical trials resulted in about 10.4 percent average weight loss over six months, and 87 percent of the weight lost in trials was fat rather than lean mass. Coverage for weight loss surgery depends on your health plan. If these lifestyle changes are not enough to help you lose weight or maintain your weight loss, your health care professional may prescribe medications as part of your weight-control program. By providing a clear and compelling case for why the weight loss services are medically necessary, you may be able to appeal the denial and get the coverage you need. If your insurance denies coverage for weight loss services, the first step is to review the denial letter and understand the reasons for the denial. Cost and coverage insights from Rich Fahn, SVP, Benefits; and Cam Kennedy, Managing Director, Benefits. "A combination of medication (if deemed appropriate by your prescriber), healthy diet and increased physical activity are all pieces of the puzzle." This is a promising first step, and it could pave the way for Medicare to eventually cover these drugs as well. These medications also come at a significant cost (with the average being $1,200 to $1,400 per month) and have experienced recent drug shortages, making access difficult at times.In this webinar, the NFP Benefits Compliance team discusses the impact of HIPAA’s Privacy and Security Rules on employer sponsors of group health plans.This convenience can be particularly helpful when navigating insurance questions or needing timely prescriptions.A total of 5 RCTs were included to examine body weight change, 4 trials to assess BMI, and 3 trials to evaluate waist circumference were included.Of people taking CONTRAVE lost at least 5% of their body weight vs 43% with placeboFirst, they should discuss alternatives with their healthcare provider, as there may be other medications that are covered under the insurance plan.Insurance companies need the doctor to write clear notes that explain why the medication is medically necessary.If you’re ready to explore whether Wegovy, Ozempic, or Mounjaro is right for you, QuickMD’s licensed providers are here to guide you every step of the way. Compounded semaglutide works in the same way as brand-name semaglutide medications. If you’ve undergone previous weight-loss treatment, get copies of your report to show that you’ve been diligently following up and following any advice your previous practitioner gave. During this visit, we document your height, weight, BMI, weight-related conditions, and prior attempts at weight loss through lifestyle changes. In addition to BMI requirements, BCBS requires documentation showing that you have made prior attempts at weight loss through lifestyle changes, including diet and exercise. If coverage is still denied, you can explore other ways to reduce costs, such as using a GoodRx coupon or applying for a patient assistance program. These medications may also be costly. GoodRx has coupons for a variety of weight-loss medications. Check your TRICARE plan for details on coverage and criteria. Do I need a doctor’s referral to get insurance coverage for weight loss programs? However, they can also make it difficult for patients to access these treatments. This could involve demonstrating that you’ve completed nutrition counseling, exercise, or other weight management activities. For obesity, Patients often need to have a BMI over a certain threshold or an official obesity diagnosis to qualify. The amount people are willing to pay for these injections varies significantly based on their income. Some insurers may include surgical options like bariatric surgery, while others limit coverage to non-surgical interventions. Taking the right steps will not only enhance your chances of receiving insurance support but could also set you on the path to achieving your long-term weight loss and wellness goals. This can help to assess your overall health and determine which programs may be medically appropriate for you. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Yes, continued approval often requires follow-up documentation showing weight loss progress and adherence to treatment. It's important to tell your healthcare provider about all of your medical conditions. Many states do not cover weight-management medications under their pharmacy benefit. Prepare to ask your healthcare provider about CONTRAVE with this personalized weight-loss assessment With support from his doctor, Brian added the medication to his weight-loss plan, alongside healthier eating habits, portion control, and a more active lifestyle. This documentation should include records of previous weight-loss attempts, medical evaluations, and letters from your healthcare provider outlining the reasons for the recommended surgery. If your insurance company denies coverage for weight loss surgery, you have the right to appeal the decision. To qualify for insurance coverage of weight loss surgery, most insurers require that patients meet certain eligibility criteria. Pursuing sustainable weight loss can be tricky, especially if you’re using weight-loss medication to reach your health goals. They’re the healthcare providers who usually have the most experience with these programs, so they should be able to give you a bit of guidance. “Most people pay out of pocket, and the price can easily exceed the cost of weight-loss surgery.” For starters, Medicare currently doesn’t cover most forms of obesity procedures and medications. Or the type 2 diabetes drug Rybelsus, which is an oral version of semaglutide that can result in weight loss even though it’s only FDA-approved for managing blood sugar in people with diabetes. Here’s some things to know about your plan and how to get the most from your health, dental and pharmacy benefits. Learn about money-saving programs and smart tips to help you get the most of your health care dollar. Knowing the basics of health insurance can help you be a smarter health consumer. Learn which plans fit your needs to help you decide when picking a plan. Medicare Part D may also cover certain weight loss medications, depending on your specific plan. The field of weight loss treatment is advancing rapidly, and insurance coverage is beginning to reflect these changes. Some states and insurance plans are adjusting their coverage policies based on new clinical evidence and cost considerations. Insurance coverage for newer treatments—particularly GLP-1 medications for weight management—continues to evolve. If you're specifically seeking coverage for weight loss surgery, it's worth comparing multiple plan options during open enrollment. They may be able to offer alternative solutions or recommendations that can help you achieve your weight loss goals, even without insurance coverage. Additionally, you may want to consider speaking with a healthcare provider or a registered dietitian who can provide guidance and support on making lifestyle changes that can help with weight loss. One option is to consider self-pay programs, which can be costly but may offer more flexibility and customization than insurance-covered programs. By documenting your efforts, you can demonstrate to your insurance provider that you’re committed to making lifestyle changes and that the weight loss services are medically necessary. It is important to note that Mounjaro is not officially approved by the FDA specifically for PCOS treatment. PCOS often involves insulin resistance, weight gain, and metabolic issues, which Mounjaro’s mechanisms may help address. Top advisers to Health and Human Services Secretary Robert F. Kennedy Jr., who now oversees CMS, among the nation's federal health agencies, had criticized the Biden-era move. This knowledge helps individuals make informed choices and find effective treatments. You need a high BMI or BMI with health issues to get these. The GLP-1 agonist class, including Wegovy, Saxenda, and Zepbound, is popular for managing weight. You’ll need to show why you need the meds, like your weight issues and past weight management tries. You might need a BMI of 30 or more, or a BMI of 27 with health problems. Many drug makers offer patient assistance programs that include discounted pricing. One option is to consider generic versions of older drugs, such as bupropion, liraglutide, or orlistat. The semaglutide group, initially losing an average of 17.3% of their body weight, returned to 5.6% below their starting weight. After one year, both groups regained at least some weight. Some insurance companies partner with local gyms or national chains to provide discounted memberships, while others may offer free or reduced-cost access to weight management programs or online health coaching. Understanding these criteria can help individuals and healthcare providers prepare the necessary justification for coverage. While some elective procedures can significantly impact a person's quality of life and mental health, they are often not covered by insurance unless a strong case can be made for their medical necessity. Always follow your health care provider’s instructions to ensure safe and effective management of your health conditions. While tirzepatide is effective for weight loss, it is not clinically appropriate for everyone. Find detailed side effects and risk information for this and other drugs on our dedicated medication page. Typically, the manufacturer recommends patients start with a 2.5 mg weekly dose for the first four weeks, and the health care provider increases the amount over time, up to a maximum of 15 mg. If your insurer approves coverage for Zepbound, you may have a copay and/or deductible. Then Bronder ran across some research about a weight loss drug called semaglutide (Wegovy). Health risks of overweight & obesity. Definition & facts for adult overweight & obesity. These documents explain the basis for coverage decisions. This will help you understand your coverage and advocate for yourself. These plans offer added benefits but typically have higher monthly premiums. Wegovy is FDA approved for weight loss. You might qualify for coverage under that condition instead. If you’ve ever tried to get insurance to cover your weight loss medications, you’ve probably encountered frustrating roadblocks.This analysis examines publicly available formularies of plans available on the federally facilitated Affordable Care Act (ACA) Marketplace in 2024 to identify how utilization management tools are used for GLP-1 agonists.Insurance coverage for weight loss services can vary widely depending on the provider and the individual’s policy.Medications such as Wegovy (semaglutide), Zepbound (tirzepatide), and Ozempic (semaglutide) have become popular for helping with weight loss.While diabetes medications may be covered easily, insurance plans often do not cover medications used specifically for weight loss.If your insurance does not cover CONTRAVE, you can still find savings through the CurAccess™ Patient Support Program.Weight loss isn’t just about looking better; it’s often about improving your health and reducing the risk of serious conditions like diabetes, hypertension, and heart disease.Two-thirds of companies with 20,000 or more workers covered them. Can Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) be used to pay for weight loss medications? Health benefits and health insurance plans contain exclusions and limitations. However, the simplest way to find drugs covered under your specific plan is to log in to your member website. To find a list of commonly covered drugs, you’ll need the pharmacy plan name. Aetna prescription plans cover thousands of drugs. The data reflects health insurance coverage as of August 2025. Additionally, the health benefits that come with significant weight loss have further driven the demand for these drugs. For many, these injections represent a breakthrough in weight loss treatment, offering a level of success that traditional diet and exercise programs often fail to provide. Clinical studies have shown that patients using these medications can lose up to 15-20% of their body weight often times in the first year of treatment. A healthcare professional can help you assess your individual health needs and provide guidance on the safest and most effective programs based on your medical history. It’s important to document any comorbidities like diabetes or hypertension, as these factors can increase the likelihood of having these procedures covered by insurance. These plans follow federal rules but are offered by private insurers. Health plans offered through the Affordable Care Act (ACA) marketplace are another option. It is run by both the federal government and each state, so the rules for drug coverage vary by state. Still, some smaller employers are starting to include obesity treatments due to rising interest and demand. Smaller companies may offer fully insured plans, which are more standard and regulated by the state. With commercial insurance, you may be able to pay as little as $25 for a 1-month supply with a Wegovy savings offer. Wegovy was FDA approved in March 2024 to reduce the risk of a life-threatening cardiovascular event in adults who are considered obese or overweight and have a cardiovascular condition. Wegovy was first approved in 2021 for chronic weight management. If you have private or commercial insurance, you can pay as little as $25 per prescription (up to a 3-month supply) with an Ozempic savings card. If necessary, enlist the help of your doctor to substantiate claims regarding the medical necessity of your treatment. Some treatments, particularly bariatric surgery, may require pre-authorization. Developing a statistically supported treatment plan that aligns with your insurer’s criteria can significantly enhance your chances of approval. The goal here is to ensure that there is recorded medical necessity for your treatment. Your first step should be to carefully review your health insurance policy. You can then gather additional information and documentation to support your appeal, such as letters from your healthcare provider or medical records that demonstrate the medical necessity of the weight loss services. Another tip is to work with a healthcare provider who is knowledgeable about the insurance coverage process and can help you navigate the system. You can ask specific questions about what types of weight loss services are covered, what the criteria are for coverage, and what the out-of-pocket costs may be. In some cases, insurance may also cover prescription medications for weight loss, such as orlistat or phentermine. Let’s say the customer service representative of your insurance company says yes, we cover weight loss medications. You can also write a letter to your employer benefits coordinator (sample attached in files) to request coverage for weight loss medications. Does your insurance cover weight loss medications? Here’s how to find out if your insurance company will cover the cost of your weight loss medication. Even before these new changes, Medicare Part D has covered GLP-1 medications, but only when prescribed for approved conditions other than weight loss alone. Many people are curious about whether their insurance provider will cover the cost of weight loss programs. Consult with your healthcare provider to determine if you qualify for insurance coverage for weight loss services. Some insurance plans cover enrollment in specialized medical weight loss programs that combine multiple approaches. This means many people can now access health insurance weight loss coverage without worrying about copays or deductibles when using in-network providers. Right now, coverage of anti-obesity medications by commercial insurance plans is mixed, and often varies by employer to employer, Horn says. Medicare, which serves people over 65, currently denies coverage for weight loss drugs like Wegovy or Zepbound. Speak with a QuickMD provider today to explore affordable GLP-1 weight loss medications without the long-term commitments or monthly costs starting at $1,000. In this issue, we asked a panel of experts to share their thoughts on options and actions people can take when they don’t have insurance coverage for obesity treatments. Finally, bariatric surgery is a highly effective option for long-term weight-loss if someone meets the criteria (as mentioned before). These criteria include other health problems such as diabetes, heart disease, sleep apnea, and others. Healthcare providers decide if treatment is needed based on certain criteria. Pharmaceutical companies might have programs to help you afford treatment based on your income. Sometimes exceptions are made if there are strong reasons for you to get specific obesity treatment. As with many healthcare services, the answer is that it depends.Private insurance coverage of weight-loss medications varies from plan to plan.Medicare typically covers Ozempic under Medicare Part D for treating type 2 diabetes but does not cover it for weight loss.Additionally, even if your insurance covers weight loss medication, there may be certain requirements or restrictions you need to meet before approval.It requires a comprehensive evaluation of the individual's overall health status, potential comorbidities, and the specific pharmacodynamics of the medication.Most experts recommend waiting six months to one year after reaching your goal weight.Some insurance providers may cover the full cost of the medication, while others may require a copayment or coinsurance.Every month LIWLI will be posting news articles with valuable weight loss and health information. That’s good news for the more than 40% of adults in the U.S. living with obesity. We’re living in a golden age of weight-loss drug innovation. Here’s how to figure out what your insurance will pay — if anything — and what you’ll be responsible for. Talk to a health care professional about how to stay on top of other conditions you may have. Medicaid’s coverage for weight loss shots covered by insurance shots varies by state. Approximately 50 million adult Americans have insurance coverage for weight loss shots covered by insurance. The cost of weight loss shots covered by insurance, such as Ozempic, can be very high, ranging from $900 to over $1,000 per month without insurance. The Affordable Care Act (ACA) Marketplace plans rarely cover drugs for obesity treatment. They’re also expensive for insurers, which is why many plans don’t automatically cover their cost.To confirm if your medication is eligible, consult the guidelines provided by your HSA or FSA plans, as rules may vary between providers.In order for us to give you results, we need to send your insurance company the name of your doctor or other health care provider.The company announced earlier this year that it would cut back on supplying doses of Wegovy for new patients to preserve the medication for those already taking it.As you may know, employers or private insurance companies decide the prescription coverage for each of their employees or members.“I think it’s terribly unfair because your health shouldn’t depend on whether you’re rich or poor,” he says.However, only about one third were willing to pay extra for them, and half disagreed with the notion that health plans should charge more to obese individuals. Check your plan’s formulary or contact member services to clarify coverage details. Without prior authorization, coverage may be denied, leaving you to pay the full cost. Below, we outline the key factors affecting coverage and which drugs may be included. The answer depends on your specific plan, medical necessity, and the medication prescribed. Costs can be high, making insurance coverage critical for affordability. This decision was based on mounting evidence that obesity is a complex condition influenced by biology, environment, and behavior, and that it can lead to other serious health conditions such as type 2 diabetes, heart disease, stroke and many cancers. If you’ve had difficulty losing weight with diet and exercise alone, it may be time to consider medical weight loss. But which of them can be covered by insurance? Keeping thorough records, such as prescription receipts and any relevant documentation from your healthcare provider, can facilitate the reimbursement process. Will Insurance Pay for Weight Loss Medication? Understanding Your Coverage Options But these buzzy drugs, which are meant to be "lifelong" drugs taken long term, aren't cheap. Geoffrey Joyce, PhD, director of health policy, University of Southern California Schaeffer Center for Health Policy and Economics. Or there may be a similar drug that your insurer will cover instead.As for Bronder, he has lost 52 pounds on Ozempic and he can’t believe how good he feels, eating simple, low-carbohydrate meals with a protein and a vegetable. It’s about cost, health benefits, saving money on chronic diseases, and making health care fairer. Also, 50% of states not covering these drugs are thinking about it for 2025 or later. Almost 40% of adults and 26% of kids with obesity in Medicaid could get help from GLP-1 drugs. Some people might pay hundreds of dollars each month, even with insurance. As obesity treatments evolve, staying updated is crucial. Your surgery must be approved by your insurance company first. Weight loss surgeries, generally referred to under the umbrella term bariatric surgeries, make physical changes to your digestive tract to aid in weight loss. As with many healthcare services, the answer is that it depends. In the future, be sure to work with a transparent and digital-first insurance company that allows you to easily access information about your plan. And how much will you have to pay for it if you do or don’t have health insurance? Some plans may cover the cost of FDA-approved weight loss drugs if they are prescribed by a physician and deemed medically necessary. Insurance coverage for weight loss medications can vary widely depending on your specific health plan. Many insurance plans cover medically supervised weight loss programs that include clinically managed diet and exercise plans. Many programs will require proof of medical necessity—especially for coverage of medical weight loss, medications, or surgical interventions. Ninety-one percent of respondents had any health insurance; of those with health insurance, 53% had private coverage, 25% had Medicare, 9% had Medicaid, and 4% had another type of health insurance. Descriptive statistics were then conducted to summarize respondents’ beliefs about the helpfulness of specific benefits, their willingness to pay for such benefits, and whether health insurance plans should be able to charge higher amounts to obese individuals. Third, responses to the question regarding whether health insurance plans should be able to charge more to obese individuals were defined as disagreeing or strongly disagreeing, as opposed to agreeing, strongly agreeing, or having no opinion. If you’re interested in pursuing a payment plan, be sure to ask your physician’s office for more information. You can pay for the surgery in advance in monthly payments over a year. The care team at Northeast Georgia Medical Center (NGMC) Bariatric Weight Loss Center is experienced at navigating the complexities of insurance companies and individual policies. Additionally, members can contact customer support directly or reach out to their insurance agent for personalized assistance. Types of Weight Loss Programs Covered by Insurance Reach out to your insurance company’s customer service department and ask about their coverage for weight loss programs. Talk to your doctor or healthcare provider about your weight loss goals and ask if they recommend any specific programs or services. Yes, you absolutely have the right to appeal if you disagree with your insurance company’s decision regarding coverage for weight loss treatment. In many cases, yes, obtaining pre-authorization is essential before beginning any weight loss treatment covered by your insurance. Documentation from your healthcare provider justifying the medical need for these treatments is usually required for insurance approval. Be prepared to ask specific questions, such as “What weight loss treatments or programs are covered? If your insurance plan covers weight loss medication, you may still be responsible for copays or deductibles. Your healthcare provider should provide detailed medical records, including your weight history, BMI, and any obesity-related conditions or complications. We take time to assess your specific situation and provide honest recommendations about what treatments can realistically achieve for you. At kalon Dermatology, we understand how frustrating it can be to work hard to lose weight only to feel self-conscious about loose skin. Most patients benefit from annual maintenance treatments to support ongoing collagen production and stay ahead of the aging process. Those with severe laxity may see improvement but should have realistic expectations about the degree of change possible without surgery. It creates a refreshed, firmer look without the dramatic change of surgery. Expanding Medicare coverage for adults with obesity While some older weight loss medications have available generics, making them more affordable, the newer drugs can come with a hefty price tag. With weight loss medications proliferating and attracting ample media attention, more patients are asking about their costs. However, coverage varies depending on your specific insurance plan, medical necessity, and whether you meet certain criteria. The landscape of weight loss medication coverage has changed significantly in recent years. Your healthcare provider will create an individualized plan for you to ensure you lose weight safely and effectively. “We were covering GLP-1 agonists for weight loss and they tripled our cost. Many focus group participants reported that their firms will no longer cover GLP-1 agonists for weight loss due to the increases in use and costs. Forty-four percent of firms with 1,000 to 4,999 workers, and 59% of firms with 5,000 or more workers, say that the use of these medications for weight loss was higher than expected. The reasoning behind Medicare’s weight-loss medication ban can be traced back to the 1990s. However, Medicare may cover certain weight-loss (bariatric) surgeries if you meet certain requirements. However, the list price for these medications can be over $1,000 per month. This complex issue of affordability and coverage is further highlighted by broader budgetary concerns. If you’re a federal employee, you may already have coverage for Wegovy. If the price drops substantially, it would make much more financial sense for insurance companies to cover them. In fact, it’s common for people to switch insurers every one to two years, whether they change jobs or choose a different plan. Predicted probabilities of beliefs about wellness benefits and opinions about insurers charging more to obese individuals, by health insurance type Although those with other insurance had a greater predicted probability of disagreeing that health insurers should be able to charge more, the effect did not persist after excluding those individuals with no opinion. No significant differences by insurance type were observed in perceiving that a specific health-related benefit would be helpful compared to a financial incentive. Twenty-seven percent of respondents reported that a financial incentive, rather than a specific weight loss–related benefit, would be most helpful. Taken together, 26% of respondents said that a weight loss program, either in the doctor’s office or via a commercial program, would be most helpful. Whether insurance will cover Ozempic depends on the plan and what the medication is being used to treat. As a result, many health insurance companies won’t cover Ozempic for chronic weight management. Healthcare professionals may also prescribe Ozempic off-label to help people who don’t have diabetes lose weight, but the medication is not FDA approved for this purpose. In most cases, insurance plans do cover pre-operative evaluations, but this can vary. Looking ahead, employers may continue to face the competing pressures of employee demand for GLP-1 drugs and concerns about costs. “So now they’re saying there’s going to be a huge increase in the utilization of GLP-1s, not just for weight loss, but you may go to a physician that may diagnose you with this condition when really you want the GLP-1s for weight loss. And so when employees realize you’re not going to cover that, they will find other alternatives and places to get GLP-1 agonists which are a 1/4 of the cost or less.” -Human Resource Representative, large manufacturer Most health insurance providers cover Ozempic when it’s being used to treat Type 2 diabetes. It is essential to consult with your healthcare provider to ensure all required assessments and documentation are completed before submitting a request for coverage to your insurer. Ensure you have a robust medical history documenting your struggles with obesity, including records of previous diets, medications, and any health issues. Navigating the insurance approval process for weight loss surgery can be arduous and often requires the involvement of both medical and administrative staff. When embarking on a weight loss journey, many individuals explore various options to achieve their health goals effectively. People were living with obesity (body mass index BMI of 30 or greater) or were overweight (BMI of 27 or greater) with at least 1 weight-related medical problem. Participants were living with obesity (body mass index BMI of 30 or greater) or were overweight (BMI of 27 or greater) with at least 1 weight-related medical problem. Use our healthcare provider finder for help. Other ways to request insurance coverage When deciding what medication to prescribe, Shauna Levy, M.D., medical director of the Tulane Bariatric and Weight Loss Center in New Orleans, says insurance is her number one limiting factor. GLP-1 is a class of medications created to treat type 2 diabetes by helping the pancreas release the right amount of insulin when blood sugar levels are high. Medicare now covers GLP-1s for diabetes and other approved ailments, such as obesity in conjunction with heart disease. Doctors have been prescribing GLP-1s for weight loss because studies have found that losing 5 percent to 10 percent of your weight can have positive effects on your health. A BMI over 40 or a BMI over 35 with obesity-related health conditions is often needed. If it doesn’t, coverage may be denied. Examples include obesity-related diabetes, hypertension, and sleep apnea. Having medical conditions that may risk complications from surgery could disqualify you. Start by reviewing your plan’s formulary online or in your member portal. Low-income users may qualify for extra help, but out-of-pocket costs remain high without approval. It might pay if prescribed for other issues, such as type 2 diabetes or cardiovascular risk reduction. If denied, you can appeal with a letter from your doctor explaining medical necessity. Consulting with your healthcare provider can also be beneficial, as they can advocate on your behalf, provide necessary medical evidence, and assist in navigating the appeals process. This ensures that the use of weight loss drugs is appropriate and safe based on the individual’s health status and weight loss needs. To determine coverage, it’s important for patients to contact their insurance provider directly. Some common side effects of weight loss medications can include nausea, gastrointestinal issues, and increased heart rate. Older, generic weight loss medicine covered by insurance drugs are usually cheaper than new, brand-name ones. Newer weight loss medicine covered by insurance drugs can be over $1,300 a month without insurance. Employer plans, however, often have more freedom to cover treatments like FDA-approved weight loss meds. This article breaks down what you need to know about securing insurance coverage for weight loss drugs. Despite this treatment being foundational to weight management and the proven benefits, health insurance coverage varies. Your personal clinician will be able to go over your options and the cost before ever writing you a prescription. Experts interviewed for this piece also note there’s likely weight bias at play. Initially approved for use in treating migraines and seizure disorders, it was shown to reduce weight in patients with a body mass index over 30, and subsequently became approved for that purpose when combined with another drug (phentermine). “This is common, and is likely in up to 20 percent of prescriptions–not just for obesity but for numerous conditions,” Seltzer says. Generally, that means a BMI of 30 and up, or a BMI of at least 27 plus a qualifying condition, such as hypertension or diabetes. The first step in determining if your insurance covers weight loss services is to review your policy documents or contact your insurance provider directly. However, some common types of weight loss services that may be covered include physician-supervised weight loss programs, nutrition counseling, and behavioral therapy. Insurance coverage for weight loss services can vary widely depending on the provider and the individual’s policy. Another barrier is that insurance providers may have strict guidelines and protocols for covering weight loss services, which can be confusing and overwhelming for individuals to navigate. However, employer plans may cover GLP-1 medicines for weight loss in approximately 25% of cases. Medicare doesn’t cover weight-loss drugs unless for the treatment of diabetes. This could affect the availability of weight loss shots covered by insurance. Flexible Spending Accounts (FSAs) work like HSAs for weight loss shots covered by insurance meds. Depending on the treatment you’re seeking, check under general physician services, surgical benefits, and prescription benefits. For support with changing lifestyle habits, there are programs like the Diabetes Prevention Program (DPP) at many YMCAs, as well as many commercial programs such as Weight Watchers, Noom, TOPS, etc. Participating in a clinical trial could give you access to new treatments and possibly some money, too. Additionally, you can do an online search for prescription discount programs such as GoodRx.