Obesity and Health Insurance: Is it a pre-existing condition?

by | October 3, 2013 | 0 Comments

obesity pre-existing insuranceEarlier this year in June, the American Medical Association voted to classify obesity as a disease.  That’s right, not just a marker for disease, but a disease it’s self.  Obviously this could affect how obesity is figured into the care Americans receive and also health insurance costs.  I thought that as we usher in the Affordable Care Act that will give access to insurance to many in the Black community who have gone without, it’s important to discuss this health issue.

How can obesity or being overweight affect health insurance?

Being overweight to become a costly matter, not to health insurance companies, but to the consumer with a weight issue in terms of the cost of treating obesity related diseases. What remains to be seen is how the new classification of obesity as a disease will impact federal regulations around insurance and premiums. This leaves those with a high enough body mass index (BMI) bearing the brunt of the new charges while it may protect the morbidly obese.

Why being overweight could now cost more to insure.

It is an accepted medical fact that being overweight can increase a person’s risk for disease and complications from other treatments to the point that it can be life threatening or develop into chronic conditions. Obesity is linked to asthma, type-2 diabetes, stroke risk, high blood pressure, cardiac issues and recently a direct link between being overweight and an increased risk of breast cancer has been found. For health insurers, this flags those who are overweight as high risks for coverage. Federal regulations prohibit insurers from denying or limiting coverage to those who are overweight by denying it qualification as a pre-existing condition, but they have put in options for health insurers to charge higher rates to the obese.

How much higher will my rates be if I am overweight?

According to the new federal regulations, you could be charged anywhere from 30 to 50% more for the same health insurance that someone who has a healthy BMI is paying. For employers, this will help defray the costs of the group insurance plans they help carry.  The many of the people with health issues that the new health mandates are supposed to be helping get affordable coverage may become stuck in the catch-22 of having to pay higher rates than before.

Is there a way to avoid the increase?

While quickly losing weight fast enough to lower your health insurance rates is neither realistic nor healthy, there is an option in place to promote weight loss and keep your rates low. If you sign on to participate in an approved wellness program (if there is one available to you) and meet the milestone goals, then your rates may not be raised as high as they would without. There are other weight-loss incentives that some companies offer.  There are also coverages available for weight loss treatments and surgeries if approved.

The complication

The AMA’s reclassified of obesity as a disease  is creating not only controversy, but complications in knowing how to follow the new regulations. If obesity is a disease, then it is protected from undue discrimination in health insurance under the guidelines for pre-existing conditions. If it is also considered a disease, then this removes the argument that many insurance companies have used to deny coverage for weight loss surgeries.  I’ll be following the news and debate on this issue.

How to go about losing weight and keeping it off

Getting down to a healthy weight is good for your health and good for your budget as well. If you are not currently involved in a weight loss program you can begin your own. Once a doctor approves exercise for you, begin to add more activity to your life. Even if all you can do is walk for 15 minutes a day, keep it brisk and get it done. The most important types of exercise to do are those that elevate your heart rate and that you can be consistent in doing. Whole body exercises, such as swimming, are an excellent choice as they will burn more calories faster and do not put strain on your joints.  Walking is also a great choice.  Eating healthy and avoiding second helpings is another key element for sustained weight loss.

What about insurance programs that are advertised for the obese?

There are special insurances targeted for the morbidly obese, but they will not give you more than the insurances provided under a normal policy except at an extra charge. With the new regulations and how they will affect decisions on bariatric surgery approval, it may be better to wait and see how the situation develops rather than jump into a higher priced, specialized plan. Special insurances for the morbidly obese may be your best option for securing life insurance, although the rates may be high as well.


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Category: Healthy Eating, Wellness and Health

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