Does Health Insurance Cover Weight Loss Surgery?
Health insurance often covers weight loss surgery.
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Where you live and the coverage you have determine what type of surgery you have access to.
Some companies only cover a few types of stomach surgeries for weight loss. You may also need to meet certain conditions before you can get surgery.
Does insurance cover weight loss surgery?
Health insurance will sometimes cover weight loss surgery depending on where you live, your health status and your plan details.
In some states, health insurance plans that follow Affordable Care Act (ACA) rules have to cover bariatric surgery. That includes plans you buy through your state marketplace and coverage you get through your job.
Other types of insurance like short-term plans and supplemental coverage don't have to follow these rules.
Companies that offer this coverage may require you to meet certain standards. For example, plans typically only cover those age 18 or older and people who have a certain body mass index (BMI). You may also need to show that you've tried other weight loss methods first.
Consider reaching out to a licensed health insurance agent if you need coverage for bariatric surgery. An experienced agent can help you compare marketplace plans in your area.
It's important to read the fine print on the plans you're looking at before you buy. Some policies may only pay for certain types of weight loss surgery. You may also have to choose an in-network doctor and commit to certain lifestyle changes before coverage starts.
States that require weight loss surgery coverage
State | Weight loss surgery coverage required |
|---|---|
| Alabama | No |
| Alaska | No |
| Arizona | Yes |
| Arkansas | No |
| California | Yes |
Do Medicare and Medicaid pay for weight loss surgery?
Medicare pays for weight loss surgery everywhere in the U.S. You might need to meet certain conditions to qualify, and Medicare only pays for some procedures, such as gastric bypass surgery and laparoscopic banding surgery. You might need to visit an in-network doctor if you have a Medicare Advantage plan.
Medicaid will pay for bariatric surgery in almost every state if you're an adult. For those under the age of 18, coverage is less common.
How much does weight loss surgery cost?
On average, weight loss surgeries cost between $17,000 and $26,000 without coverage.
The amount you pay for weight loss surgery depends on the type you choose. For example, gastric bypass surgery tends to cost more than gastric sleeve surgeries. Ask your doctor to recommend the best procedure for you.
Weight loss surgery usually costs more than weight loss drugs, which average $12,996 per year without insurance and $3,900 per year with insurance. But, you only need to pay for weight loss surgery once, while weight loss drugs require ongoing payments.
How to find insurance that will cover weight loss surgery?
To find the best insurance companies for weight loss surgery, it's a good idea to check plan details when shopping around. You might also consider working with a licensed health insurance agent in your area.
Keep in mind that there's no one best health insurance company for weight loss surgery nationwide. That's because what's covered depends more on where you live and what plan you choose than your insurance company.
With that said, it's still a good idea to pick a company that has a good customer service reputation to prevent headaches down the road. You should also pay attention to your total expected cost, including your monthly rate and any costs you're responsible for when you go to the doctor like your deductible, copays and coinsurance.
Does Blue Cross Blue Shield insurance cover weight loss surgery?
Some Blue Cross Blue Shield (BCBS) plans cover bariatric surgery.
Whether your Blue Cross Blue Shield plan covers weight loss surgery depends on where you live, the individual BCBS company you choose and your plan details. Other large health insurance companies work in a similar way. For example, some Aetna, Cigna and UnitedHealthcare plans cover weight loss surgery.
However, it's important to check your policy details before you buy. That's because not all plan types cover bariatric surgery if you live in one of the 27 states that don't require that insurance companies cover weight loss surgery.
Frequently asked questions
Does insurance cover weight loss surgery?
Many health insurance plans cover weight loss surgery, but coverage depends on your plan details and where you live. Currently, 23 states require private health insurance to pay for bariatric surgery.
How much is gastric sleeve surgery?
Bariatric surgery costs between $17,000 and $26,000 without insurance. If you have insurance, you'll pay your deductible and any coinsurance required by your insurance plan up to your annual limit, called an out-of-pocket maximum.
Do most insurance companies cover weight loss surgery?
Most major health insurance companies cover weight loss surgery. Keep in mind that coverage depends on your specific policy details rather than the company you choose.
Sources
Average bariatric surgery costs came from the American Society for Metabolic and Bariatric Surgery. The list of states that require coverage of bariatric surgery on ACA plans came from the American Society for Metabolic and Bariatric Surgery. Information about required coverage offerings on ACA plans is from HealthCare.gov.
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