Obesity uncovered: diagnosis without treatment in plans offered on the 2015 health insurance marketplaceLeathers, Sally Caine (2016) Obesity uncovered: diagnosis without treatment in plans offered on the 2015 health insurance marketplace. Master's Thesis, University of Pittsburgh. (Unpublished)
AbstractBackground: Obesity is a public health problem that currently affects more than one-third of American adults. The Patient Protection and Affordable Care Act (ACA) requires all private health plans to cover diagnostic screening and counseling for obesity. However, the ACA does not guarantee access to effective treatment for obesity. Objective: To examine the health plans sold on the 2015 Health Insurance Marketplace (Marketplace) by describing the coverage and access barriers for surgical and non-surgical treatments for obesity. Methods: Using data from the 2015 Marketplace Public Use Files that consist of a census of all health plans sold on the 2015 Marketplace in 37 states, which excludes plans sold on the 14 State-based Marketplaces. Descriptive statistics are employed to characterize the plans’ coverage, exclusions, limitations, and out-of-pocket costs for bariatric surgery (surgical category), dietician services, nutritional counseling, gym access, gym membership, gym membership reimbursement, and weight loss programs (non-surgical category). Results: Bariatric surgery was covered by 30.4% of plans. Of these plans, over one-third applied a limit on the coverage amount. Of the plans covering bariatric surgery with a copayment, 60.3% of these plans had a copayment of $1,000 or more. In contrast, the non-surgical treatments were covered by more than 80% of plans. Of these plans with a copayment, 71.6% had a copayment between $1 and $49. Of the plans covering treatments in the surgical or non-surgical categories, coinsurance rates were more prevalent than copayments, with almost two-thirds of plans having a coinsurance rate of 50% or more. Conclusions: A majority of plans on the 2015 Marketplace covered non-surgical obesity treatments. However, bariatric surgery, the treatment that results in the greatest amount of weight loss, was covered by less than one-third of plans. Furthermore, bariatric surgery, even when covered, may be less accessible to patients with a Marketplace plan due to high cost sharing and limits on the coverage amount. This study is significant to public health because it provides an early description of the coverage and access barriers to obesity treatments available to Marketplace enrollees, highlighting the importance of promoting policy that expands coverage of and access to obesity treatments given the high prevalence of obesity in the U.S. Share
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