Does Obamacare cover weight loss surgery ?

[brendat559 0]

Does the Obama plan cover my weight loss surgery ?

[Alex Brecher 10,498]

It really depends on your state. You need to check your state health insurance marketplace to see if there are plans that cover weight loss surgery. Certain states offer them and certain states offer them at a premium.

Twenty-two states chose benchmark plans that cover bariatric surgery:

• Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming

Five states chose benchmark plans that cover weight loss programs:

• California, District of Columbia, Massachusetts, Michigan, New Mexico

Twenty-eight states chose benchmark plans that cover neither bariatric surgery nor weight loss programs:

• Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin

One state covers weight loss programs but not bariatric surgery:

• District of Columbia

[2muchfun 8,927]

Great research Alex!!!

[mrsto 2,925]

Great research Alex!!!

Ditto!

[HealthyNewMe 1,935]

Good old Louisiana...... The home state motto of: "We don't eat to live..... We live to eat!" ...

doesn't cover either. Figures!

[B-52 7,113]

The bigger question, and one that has many concerned, is will they PAY for it?

Currently, Medicare approves many procedures, but will reimburse next to nothing...

The number of Dr.'s refusing to accept Medicare is increasing everyday....and that is a federal program they have been trying to perfect for years and can't get it right......so how are they going to have something like Obama care be better???

If they did know the answer to that, then all they needed to do is perfect Medicare...and no need to start another federal program.

My Wife is a Director for a large Rehab facility, and they cannot get a straight answer as to what Obama Care will cover for Therapies, room and board, and most of all how many days, say for a post op total hip replacement patient, is eligible for....5 days? a week? 2 weeks?...no one knows....so they cannot accept any Obama Care Patients for admissions at the moment.....yet people are signing up for the coverage everyday...

We have hardly scratched the surface on this...it is going to get a lot more interesting as time goes on, and find out what they were never told....

Edited January 1, 2014 by B-52

[mrsto 2,925]

I'm thankful that I live in California, based on the current benchmarks posted by Alex. I still think it's going to be a "wait & see" issue. When I called my bariatric group, they told me that they're already seeing the coverage drop off. It's all very disconcerting....

[kll724 3,055]

Thanks for the updates, everyone, especially Alex! Your research is vitally invaluable to us on this site. Happy New year, Karen..aka..kll724

[NaNa 878]

It really depends on your state. You need to check your state health insurance marketplace to see if there are plans that cover weight loss surgery. Certain states offer them and certain states offer them at a premium.

Twenty-two states chose benchmark plans that cover bariatric surgery:

• Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming

Five states chose benchmark plans that cover weight loss programs:

• California, District of Columbia, Massachusetts, Michigan, New Mexico

Twenty-eight states chose benchmark plans that cover neither bariatric surgery nor weight loss programs:

• Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin

One state covers weight loss programs but not bariatric surgery:

• District of Columbia

Alex,

Thanks for the complete list! It's very clear and useful for many!

[Terry Poperszky 2,784]

It really depends on your state. You need to check your state health insurance marketplace to see if there are plans that cover weight loss surgery. Certain states offer them and certain states offer them at a premium.

Twenty-two states chose benchmark plans that cover bariatric surgery:

• Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming

Five states chose benchmark plans that cover weight loss programs:

• California, District of Columbia, Massachusetts, Michigan, New Mexico

Twenty-eight states chose benchmark plans that cover neither bariatric surgery nor weight loss programs:

• Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin

One state covers weight loss programs but not bariatric surgery:

• District of Columbia

So, what you are saying is that it is the State's decision as to whether or not they will cover bariatric procedures and is not a function of the ACA itself?

[sunstar721 13]

In Nevada. . Covered

[RebekahL 1]

I have been researching this heavily in Arizona. So far, I have found that many of them cover bariatric surgery. Most will only cover gastric bypass. You have to read the Explanation of Benefits soooo closely. They don't specifically exclude sleeve under the topic of bariatric surgery, but then if you read further down under gastroplasty, laproscopic gastric sleeve procedure is specifically excluded. This really bothers me. They recognize it as an accepted procedure for medical necessity in treatment of obesity, but they refuse to cover that specific procedure under Obamacare. I am very, sad right now. I don't know what to do really. :/ I can't afford the cash to get the procedure, I really need it, and prefer the idea of sleeve over bypass for many reasons. I just think its really sneaky of them to try to hide that they don't cover it by not specifically stating it under the topic of bariatric surgery. :/

[sunstar721 13]

It just depends on who the carrier you use. Here is nevada they have a hand full of different companies and plans you can go with. I research what each plan covered and chose one that covers it. Some did not.

[amponder 396]

@@Alex Brecher I live in KY and have Coventry Cares of KY mine was covered and approved within 2 weeks of finishing a 6 month of Dr. Supervised weight loss. It will cover it if you have 2 co morbidities and a BMI of 35, it will cover a BMI over 40 almost automatically.

[amponder 396]

oops old post I suppose insurance has changed over the past year.