Weight Loss Medications and Insurance
Weight loss medications can be a huge benefit for older adults who are struggling with weight. These drugs are approved by the FDA and can be an effective supplement to diet, exercise, and lifestyle changes. However, insurance coverage for these medications varies by state. Currently, Medicare and Medicaid do not cover these drugs, nor do most employer plans.
However, some insurers do cover weight loss surgery, if it is medically necessary and meets strict eligibility criteria. To qualify, a patient must have a qualifying body mass index (BMI), a health condition related to obesity, and have unsuccessfully tried to lose weight. Some procedures are not covered by Medicare, such as open sleeve gastrectomy and gastric balloon. Those who qualify for Medicare will still need to pay standard costs.
Some anti-obesity medications are covered by Medicare, though not all. Medicare does cover certain treatments for obesity, such as behavioral therapy and pharmacotherapy. However, there are many weight loss treatments that are not covered by Medicare, creating a gap in the care for older adults.
The Affordable Care Act has made certain medications and procedures for obese people covered by health insurance. Many insurers have started covering these treatments, including high-doses of diabetes medication. But the coverage varies between insurers and patients. It is advisable to check with your insurance provider to ensure that your plan covers these procedures before beginning a treatment program.
Health insurance can also cover Weight Loss Medications and Insurance and services. Many states have passed laws requiring insurers to cover them, including bariatric surgery. However, short-term health plans don’t cover these treatments. This makes it crucial for those who suffer from obesity to find a health plan that covers these procedures.
Fortunately, Aetna has a policy that considers Plenity (Gelesis, Inc.) to be medically necessary for weight loss. This device is often used in conjunction with a healthy diet and exercise program to help people lose weight. However, many Aetna benefit plans have a policy exclusion for weight reduction medications.
The most common prescription weight loss drugs help you control your appetite and reduce the amount of food you eat. Most of these medications are accompanied by side effects, such as dry mouth or nausea. However, they can help you lose up to 7% of your weight over a year, and can reduce your blood pressure and triglyceride levels. If you are considering a medication for weight loss, discuss your options with your physician. Weight loss drugs can be costly, so you need to make sure your insurance covers the cost of the medication.
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