The 2025 Open Enrollment period for many healthcare plans, including private insurance, Affordable Care Act (ACA) plans, Medicare and Medicaid, is now underway. Open Enrollment happens annually, giving you the chance to review your insurance coverage and make sure it meets your current healthcare needs. During this time, you can enroll in, re-enroll in, or change your insurance policies, with changes taking effect in January 2025. Be sure to check specific Open Enrollment dates and deadlines for your insurance plan.

When evaluating your insurance options, it’s import to ensure your policy includes coverage for any obesity treatments you may be using or considering as part of your management of this chronic disease. Here are some key questions to consider when assessing your insurance policy for obesity treatment coverage:

  • Does this insurance policy cover obesity treatment(s)?
  • What specific obesity treatment services are covered? For example, does it cover medical consultations, medications, surgeries or counseling?
  • Are there any restrictions or limitations on obesity treatment coverage?
  • What are the pre-authorization requirements for obesity treatment services?
  • Are there any exclusions or waiting periods for coverage of obesity treatments?
  • Does the policy require meeting specific criteria for coverage, such as a certain body mass index (BMI) or related medical conditions?
  • Are there lifetime or annual maximum limits on obesity treatment coverage?
  • What co-pays, deductibles or co-insurance amounts will you be responsible for paying for these services?
  • Are there additional resources or support programs available for weight management? For example, does the plan include access to nutritional counseling or exercise programs?
  • What documentation might be required to support the need for obesity treatment services, such as medications or surgery?
  • How often are follow-up visits or ongoing care covered?
  • Does the insurance cover prescription medications used for weight management?

Remember, coverage for obesity treatments might be listed under various sections of your insurance plan. Make sure to also check under exclusions. Note that prescription coverage may be separate from medical benefits.

Review your insurance policy carefully, and ask these questions to your insurance provider or your employer’s benefits representative to fully understand the terms and any limitations. If your employer offers informational sessions about benefits, use these opportunities to ask specific questions about obesity treatment coverage.

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The OAC continues to fight for access to obesity care and treatments for all who seek them. Help us in this fight by making a donation today!