Does Medicaid Cover Obesity Treatment

Does Medicaid Cover Obesity Treatment

Medicaid and CHIP can provide various services to prevent and alleviate obesity, including BMI screening, nutrition and physical activity education, weight loss medication, and, in some cases, bariatric surgery. Such services are available to children under EPSDT.

State Medicaid programs offer coverage for FDA-approved medications for treating obesity.

Does Medicaid cover obesity?

Medicaid coverage for obesity treatments varies widely among states.

Does Medicare cover behavioral therapy for obesity?

Yes, Medicare does cover behavioral therapy for obesity, which includes screenings, dietary assessment, and behavioral counseling for enrollees with a BMI of 30 or higher. These services have no out-of-pocket cost for the enrollees.

Are prescription drugs for obesity covered by insurance?

Prescription drugs for obesity may be covered by insurance, depending on the plan. The Affordable Care Act prohibits charging higher premiums or denying coverage based on body size. Obesity medicine is a specialty focusing on comprehensive care for people with higher weights.

Does Medicaid cover bariatric surgery?

Medicaid coverage for obesity treatments varies widely and while some Medicaid programs and state employee plans cover anti-obesity medications, only bariatric surgery is consistently covered by Medicaid.

CMS provides coverage for intensive behavioral therapy for obesity for patients with a BMI of 30 kg/m2 or higher, effective for claims with dates of service on or after November 29, 2011. This coverage aims to prevent or detect early illness or disability.

Does Medicare cover obesity screenings & behavioral counseling?

Medicare covers obesity screenings and behavioral counseling if provided by a primary care doctor or other primary care provider in a primary care setting to coordinate a personalized prevention plan with other care.

Does Medicare cover high intensity behavioral counseling and therapy?

Yes, Medicare covers high intensity behavioral counseling and therapy for beneficiaries with obesity who are competent and alert at the time of counseling and are receiving treatment from a qualified primary care physician or primary care practitioner in a primary care setting. This service is covered under Intensive Behavioral Therapy for Obesity (CAG-00423N).

Should CMS develop a certification program for intensive behavioral therapy for obesity?

One commenter suggested the development of a certification program by CMS for intensive behavioral therapy for obesity practitioners that offer the USPSTF elements. Another commenter requested that CMS clarify the definition of primary care clinicians who are qualified to provide intensive behavioral therapy for obesity.

How often should intensive behavioral therapy be provided for obesity?

Commenters agreed that intensive behavioral therapy for obesity should be provided at high intensity, once per week or once every two weeks.

Does Medicaid cover obesity treatment?

Medicaid covers obesity treatment for children through the EPSDT benefit, and most states choose to cover at least one form of obesity treatment for adults.

Does Medicaid cover anti-obesity drugs?

Medicaid coverage for anti-obesity drugs is not consistent across all states. States have the choice to cover weight loss medication, but it is not mandatory. Insurance coverage for obesity drugs is often limited.

Does Medicare cover weight loss?

Medicare covers obesity screenings, counseling, and surgery. Weight loss programs may also be covered if prescribed for a specific medical condition.

How does Medicaid work in a state?

Medicaid operates in each state within federal guidelines and with varying state options in exchange for federal funds. It provides healthcare coverage to low-income individuals and families, as well as those with disabilities or who are elderly. Each state has its own Medicaid program, and the federal government provides matching funds for state spending on eligible services. Medicaid coverage and access, as well as state spending on the program, vary by state.

How is Medicaid & CHIP changing?

Medicaid and CHIP programs in every state are undergoing changes and improvements. Most states are broadening coverage for low-income adults, while all states are modernizing their eligibility, enrollment, and renewal processes and systems. These changes are taking advantage of new flexibilities provided by the Affordable Care Act. Information on these changes can be found in State Profiles for Medicaid.

Where can I find information about state Medicaid plans?

Information about state Medicaid plans and waivers can be found on, which is managed by the Centers for Medicare and Medicaid Services (CMS). Individuals can also contact their state Medicaid office to determine which services are covered and to learn about Medicaid waiver programs that may provide coverage to those who do not meet traditional eligibility requirements.

Does Medicaid cover LTSS?

Medicaid may cover Long-Term Services and Supports (LTSS) through certain waivers that waive Medicaid eligibility requirements for certain individuals. The coverage varies by state, and individuals can contact their state Medicaid office to determine which LTSS are covered.

Prescription drugs for obesity and medical treatments for eating disorders are both generally covered by insurance plans. Additionally, the Affordable Care Act prohibits higher premiums or denial of coverage based on a person's body size.

Do all health plans cover obesity?

It is important to note that all health plans are different and vary in their coverage of obesity care. Some health plans may cover obesity screenings and counseling, as well as prescription medication and weight-loss surgery, while others may not. It is advisable to consult the summary of benefits and coverage (SBC) for specific details regarding a particular health plan's coverage of obesity treatment.

Does health insurance cover weight loss?

Health insurance may cover the treatment of conditions contributing to heavier weight, BMI screenings, counseling, weight-loss surgery for eligible individuals, and prescription medications for weight loss.

This passage discusses the coverage for bariatric surgery under Medicare, Medicaid, and private insurance companies. It explains how to check if your insurance company covers bariatric surgery.

Does insurance cover bariatric surgery?

Bariatric surgery may be covered by insurance, including Medicare and Medicaid in some cases. It is important to check with the insurance company to see if coverage is available. Some insurance providers that may cover bariatric surgery include United Healthcare, Kaiser Permanente, and Humana.

What are the requirements for Medicaid for bariatric surgery?

Medicaid requirements for bariatric surgery include being over the age of 13 (females) or 15 (male) with a BMI over 35 and one co-morbidity such as high blood pressure, diabetes, high cholesterol, arthritis, depression, morbid obesity, or sleep apnea. Patients under 21 must have a BMI greater than 40 and one co-morbidity. Medicaid does cover bariatric surgery.

How much does bariatric surgery cost?

The cost of bariatric surgery can vary between $15,000 to $30,000 depending on various factors such as location, type of surgery, and the patient. Medicaid often covers weight loss surgery if the patient meets certain criteria.

Does Medicaid cover weight loss surgery?

Medicaid covers weight loss surgery if certain criteria are met, including the individual being over the age of 13 for females and 15 for males, and having no medical issues that would prevent surgery.

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Obesity Category