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June 17, 2021 / Brittany Cardwell, RDN, LD

Can Your Meal Plan Get Covered by Health Insurance?

Young female doctor in navy scrubs smiling with arms crossed, other medical professionals lined up in a row behind her.

Health insurance coverage can vary greatly depending on the type of plan an individual has, but generally speaking, preventative care has not always been affordable or accessible. Although insurance providers have been required to cover eligible preventative services- such as annual physicals, immunizations and certain tests and screenings- the focus has been more on diagnostic care, or treating symptoms and ailments that already exist.

According to the CDC, chronic diseases, including heart disease, cancer, and diabetes, are the leading causes of death and disability in the United States and the leading drivers of the Nation’s $3.8 trilllion in annual health care costs. With chronic diseases being among the most prevalent, costly, and preventable health conditions, insurance providers have started to cover more preventative services beyond routine care.

The goal of preventative care is to minimize the occurrence of chronic diseases and detect other health problems before symptoms develop. In this article we’ll discuss some preventative services and answer the question: are meal plans, such as PlateJoy, covered by health insurance? Spoiler alert, the answer is yes!

Why Does Healthcare Cover Certain Weight-Loss Services?

Obesity, defined as a body mass index (BMI) of 30 or greater, can be caused by a combination of factors including behavioral, community, genetics, diseases and/or medications. This is a condition that was prevalent in 42.5% of adults aged 20 and older in the United States from 2017-2018. Compared to adults with a healthy weight, people with obesity are at a substantially higher risk of morbidity from many chronic diseases, including but not limited to:

These health conditions not only impact the individual, but also have a significant effect on providers of health insurance. According to a study published in 2008, obesity-related medical care costs in the United States were estimated to be $147 billion. An analysis conducted by Finkelstein and colleagues in 2006 found that per capita medical spending for obese individuals was 42% higher compared to individuals of a normal weight, while Cawely and Meyerhoefer found that per capita medical spending was 150% higher for obese individuals.

If left unchecked, obesity trends will continue to rise leaving a cost burden for both subscribers and providers of health insurance. The health and financial risks associated with obesity are known, which is why healthcare insurers are covering more weight loss services.

Weight Loss Services That Your Healthcare Provider May Cover

For healthcare subscribers who are screened and diagnosed with obesity, insurance providers may cover the following services to better support weight loss:

Medicare, the federal health insurance program primarily for individuals aged 65 and older, covers a variety of weight loss services including some weight loss surgery procedures under certain conditions. However, prescription weight loss medications are not typically covered on basic Medicare plans. It’s important to research and select a plan that has the benefits that are right for you.

Weight loss screening and counseling

The Affordable Care Act (ACA) requires most insurance plans to cover basic obesity screening and behavioral counseling as preventative care. Health care providers screen for obesity using a BMI measurement, which estimates a person’s body fat based on their height and weight. An individual with a BMI of 30 or more is considered obese and can qualify for weight loss counseling with no out-of-pocket costs. Weight loss counseling involves behavioral counseling and/or therapy with a medical professional. The goal of counseling is to help a person lose weight and sustain weight loss through lifestyle intervention- diet, exercise, and self-management education Qualifying weight loss services will vary between health plans. As an insurance subscriber it’s important to advocate for yourself to ensure you receive accurate treatment for the coverage you’re entitled to.

Weight-loss medication

Medication may be prescribed to obese adults- or those who are overweight (BMI of 25 or more) with existing weight-related health problems- that are struggling to lose weight despite lifestyle changes. When combined with lifestyle interventions, prescription medications can help to treat overweight and obesity by decreasing hunger, increasing the feeling of satiety, or by reducing the amount of fat the body absorbs.

There are currently only four prescription medications that are FDA-approved for overweight and obesity treatment long-term. Due to the mechanisms and warnings associated with each, the decision to take medication for weight loss needs to be discussed with a doctor. Common side effects include diarrhea, dizziness, increased heart rate and insomnia, among other potential risks. Some, but not all insurance plans cover weight loss medications and not all adults who are overweight and obese will benefit from this weight loss treament.

Bariatric surgery

Weight loss surgery, also referred to as bariatric surgery, is another weight loss service that health insurance providers may cover for qualifying individuals. According to the American Society for Metabolic and Bariatric Surgery, qualifications for surgery typically include:

The goal of bariatric surgery is to improve the body’s ability to achieve a healthy weight and prevent future health problems associated with obesity. There are different types of surgeries including gastric bypass, gastric sleeve and lap band procedures. Each of these involves making a change to the anatomy of the stomach and/or small intestines.

Although bariatric surgery has its benefits, such as immediate weight loss and improved obesity-related health conditions, it’s a major procedure that poses serious risk and long-term side effects. Surgery is not a cure for obesity, but rather a tool to complement lifestyle changes to support a healthy weight loss. It’s important to discuss the benefits, risks, and complications with a bariatric surgeon.

Weight management programs

There are a variety of weight management program options available committed to helping people achieve and maintain weight loss success. Health insurance providers may cover such programs that offer meal benefits such as:

Can your meal plan get covered by health insurance? Check with your insurer or employer to see what services may be reimbursed by your health care plan. Many do provide coverage and reimbursement for weight and disease management programs.

Insurance Covered Weight-Loss Services Positively Impact Insulin Resistance, Prediabetes, and Diabetes

Some insurance plans will cover additional weight loss services but only for those who are overweight with a diabetes-related diagnosis. Compared to adults with a “normal” weight, the prevalence of type 2 diabetes is 3-7 times higher in individuals with obesity. Insulin resistance is an important component in the development of type 2 diabetes as it occurs in the body even before a diagnosis.

Insulin is a hormone produced by the pancreas that allows glucose (sugar) to move from the bloodstream into the body’s cells. Type 2 diabetes is diagnosed when the pancreas is no longer producing enough insulin, or the cells in the muscles, fat, and liver become resistant to insulin, causing blood sugar levels to rise too high. If left untreated, high blood glucose can damage blood vessels leading to more serious health complications.

Weight loss is an important goal for individuals affected by obesity as a 5-10% weight loss can improve insulin resistance and prevent the onset of type 2 diabetes. Lifestyle intervention and behavior modification can successfully treat those affected by obesity, insulin resistance, and/or diabetes.

Diet is a key factor in weight loss programs. Following meal plans tailored to a diabetes diagnosis, such as a prediabetes diet plan or diabetic meal plan, can help a person control energy intake and limit carbohydrate consumption to stabilize blood sugar levels and promote weight loss. See if your meal plan can get covered by health insurance by taking this quiz at solera4me.com.

The Takeaway

Weight loss is a key factor in preventing and minimizing the risk of obesity related chronic health conditions. Successfully treating obesity decreases rates of chronic disease and yields long-term cost savings for both the insurance provider and subscriber. Because of this, health insurers are covering more and more preventive care including weight loss programs and meal planning services.

It’s possible you can get your custom meal plans covered by health insurance. Be an advocate for your health and contact your insurance provider regarding your covered services.

Brittany Cardwell, RDN, LD
Health Coach and Registered Dietitian Nutritionist @ PlateJoy

Brittany is a registered dietitian nutritionist with the Commission on Dietetic Registration and a licensed dietitian with the Ohio Board of Dietetics and the Tennessee Board of Dietitians. She is a graduate of Miami University (Ohio) with a Bachelor of Science in kinesiology and health, and holds a Certificate of Training in Adult Weight Management. An Ohio native, Brittany currently resides in Nashville with her husband, son and their fur baby. In her free-time she enjoys exploring new restaurants and coffee shops, attending barre classes and being outdoors.

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