Health Insurance for Bariatric Surgery
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Weight loss surgeries, also called bariatric surgeries, are covered by health insurance only in some cases, but it depends on your state, company, plan and health metrics.
Does insurance cover weight loss surgery?
Health insurance covers weight loss surgery in some cases.
In some states, health insurance plans that are compliant with the Affordable Care Act (ACA) are required to provide coverage for bariatric surgery. In other states, plans aren't required to cover weight loss surgeries and even if they do, you'll likely need to meet certain qualifications. Those often include being over the age of 18, having a certain minimum body mass index (BMI) and having evidence that other weight loss methods have not worked for you.
If you're specifically looking for bariatric surgery insurance, it can be helpful to work with a licensed health insurance agent and closely read the details of the plans you're considering.
How much does weight loss surgery cost?
On average, weight loss surgeries cost between $15,000 and $25,000, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Keep in mind that there are different types of bariatric surgeries. The average Lap-Band surgery cost or gastric band surgery cost is different from the average cost of a procedure like gastric bypass surgery, which tends to be more invasive.
How much does insurance cover for bariatric surgery?
Weight loss surgery isn't covered by all health insurance plans, so check your policy carefully or talk to a licensed health insurance agent about your coverage.
If your health insurance does cover weight loss surgery, you may first need to meet qualifications. For example, you may need to have a BMI over a certain number or display other risk factors, like high blood pressure or diabetes. Costs for bariatric surgery vary by state, company and health insurance plan, so you'll need to discuss costs directly with a health care professional and your insurance company.
If you do have coverage, your individual plan will determine your total cost. So if you're looking for the cost of a procedure like a vertical sleeve gastrectomy (VSG) or a gastric band surgery with insurance, you'll have to check the details of your coverage to know how much you'll pay.
Plans with lower deductibles, lower coinsurance and lower out-of-pocket maximums typically cost more to purchase but provide more coverage. Ultimately, this means lower out-of-pocket costs for covered expenses. Plans with higher deductibles and other limits are likely to have cheaper premiums but lead to higher costs for covered medical care.
Best health insurance for weight loss surgery coverage
If you're wondering what health insurance companies cover weight loss surgery, you should check different plan details or work with a licensed health insurance agent in your area.
Some states require that ACA-compliant policies cover bariatric surgery, while other states don't. But if you live in a state where weight loss surgeries aren't required to be covered, you're not out of luck. Just because companies aren't required to offer coverage for weight loss surgery doesn't mean they don't offer coverage. Talk to your current company or review your coverage options to find out which company is best for you.
Whether you're buying individual coverage or you have insurance benefits from your employer, be sure to compare different coverage levels. More coverage usually means higher rates but lower out-of-pocket costs. If you find a plan that covers bariatric surgery and you know that is something you want to pursue, it may be worth the higher cost for coverage.
Frequently asked questions
How do you get approved for weight loss surgery?
Your doctor will work with you to decide if weight loss surgery is the right option, but qualifications usually involve a high BMI and a risk of other medical conditions. Insurance companies often have their own qualifications, so if your insurance does cover the surgery, be sure to make sure you qualify for coverage.
Will insurance pay for other weight loss methods?
Insurance might pay for some weight loss methods, but it will depend on your specific plan. All individual plans purchased through the federal marketplace or a state marketplace are required to cover obesity screening and counseling. The cost should be free with an in-network doctor, so be sure to check your plan carefully.
Is a weight loss program a qualified medical expense?
A weight loss program can be a qualified medical expense, but not in all cases. You may be able to use the funds in a health reimbursement account (HRA), health savings account (HSA) or flexible spending account (FSA) to pay for a weight loss program. You'll likely need a letter of medical necessity (LMN) from your doctor to confirm that the program is of medical importance and not an elective expense.
Sources
Average bariatric surgery costs were compiled by the National Institute of Diabetes and Digestive and Kidney Diseases. The list of states that require coverage of bariatric surgery on ACA-compliant plans is from the Urban Institute. Information about required coverage offerings on ACA-compliant plans is from HealthCare.gov.