Whether you’re on a weight loss journey of your own or not, you probably haven’t been able to avoid hearing about the sudden popularity of medications like Ozempic® — a diabetes drug that had major shortages when doctors discovered that it could be used as an effective obesity medicine and weight loss tool.
Some people’s first thoughts may have been about which celebrities are taking weight loss drugs, but if you’re struggling with weight gain or worried about cardiovascular health conditions, your first question may have been who would be footing the bill: you or your health insurance provider.
If you have a modest income, are struggling with your weight and eyeballing the health benefits of obesity medications, we have to be honest that the reality of how these drugs might affect your wallet is pretty grim.
Below we’ve explained who might be able to get their medications covered by insurance, how to do so if you think you qualify and what to do if you can’t get coverage, but still want to stave off heart disease (or just love the way you look again).
(Related: Metformin For Weight Loss: Does It Work?)
Are Weight Loss Drugs Covered by Insurance?
The short version of the very long answer to this question is no, weight loss drugs are not typically covered by insurers — at least not for the purpose of weight loss alone.
There are several drugs used both on and off-label to treat obesity and promote weight loss, but very few, if any, of them are covered by the majority of insurance providers.
The Affordable Care Act (ACA) did create some additional coverage for Americans with obesity or high body weight, along with related medical procedures like bariatric surgery. In general, elective weight loss is almost never covered by insurance, and when coverage is available, it’s only in circumstances where a person’s body mass index (BMI) is above certain levels.
For example, the ACA changes did not include so-called obesity drugs like the Novo Nordisk® medication semaglutide — also known as Ozempic — which is only approved by the Food and Drug Administration for people with type 2 diabetes. But a drug like Wegovy®, which is FDA-approved for people with a BMI over 27, may be covered for weight loss (in some circumstances).
To find out if you’re going to have a chance at getting covered, start by looking at your policy. If you see indications that you may be covered, there are a few steps you’ll then need to follow to make sure you’re not stuck paying out-of-pocket later on.
(Related: Are Weight Loss Drugs Covered By Insurance?)
How to Get Weight Loss Medication Covered by Insurance
To get your weight loss medication covered by your insurance in the United States, you’ll need to do a few things:
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Make sure your insurance policy covers the medication in the first place. Most providers will not offer coverage, but those who do may have strict requirements to approve yours.
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Talk to your healthcare provider about your needs. They may need to write a note seeking prior authorization to confirm your health insurance plan will cover it.
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When in doubt, appeal. If your coverage is unclear or your insurance company denies your request, you have the chance to appeal their decision. Often the appeal significantly increases your approval chances.
Even if you get your weight loss medication covered, you may need to pay a copay, so your cost still may not be zero.
What to Do if You Can’t Get Insurance Coverage for Weight Loss Drugs
Weight loss drugs look like the silver bullet for obesity and more moderate problems with weight, but they’re pretty new in general and even newer to being used exclusively for weight loss. There’s a lot of research that still needs to be done about their long-term effects on blood sugar, the digestive system and many other areas of health and well-being.
We understand if those risks keep you from pursuing an appeal after coverage for a weight loss drug was denied, or if they make you wary of weight loss medications in general. We also understand that even if you want to use a medication like Ozempic or Wegovy, it might just not be in your budget.
But if your weight is elevated, it can cause issues for your cholesterol, blood pressure, immune health and cardiovascular function — making it important to at least consider weight loss if you have obesity or are very overweight
While they’re by no means as simple as an injection or a super pill, the National Institutes of Health (NIH) point to the following weight loss solutions for people dealing with obesity and extreme weight problems:
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Diet modification
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Behavioral intervention
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Exercise
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Surgery
For people with less severe weight issues, surgery is not often necessary, and lifestyle modifications (especially those to your diet) can help greatly.
Another option? Walking. While the 10,000 step-a-day number isn’t exactly the perfect number to lose weight and extend your life, a 2022 meta analysis found that adults under 60 can see a reduced risk for something called “all-cause mortality” for each step they take — up until the 8,000 or 10,000 mark, after which the benefits drop off.
A 2015 study also found that it takes an average of 300 minutes of exercise a week, alongside changes to their diet, for a person to initiate weight loss. More strenuous and higher-intensity exercise can reduce the number of minutes needed.
(Related: Weight Loss Injections: Are They Safe?)
Weight Loss Drugs and Insurance Coverage
Prescription drugs for chronic weight management are on everyone’s radar right now — not just those with conditions like obesity. Unfortunately, most insurance plans don’t cover them, even though FDA-approved drugs like Ozempic may prevent high blood pressure and other health conditions down the road.
If you’re trying to get help with weight loss, keep the following in mind:
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Generally, most insurance companies and insurance plans will not cover weight loss drugs, even for people with weight-related conditions. You’ll have to pay for them yourself.
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If you have obesity, type 2 diabetes or a high BMI, a limited number of providers like Medicaid and Medicare may cover the costs of these medications.
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Some pharmaceutical companies offer coupons or other discounts for those who might not be able to afford weight loss medications, which may be enough to offset your out-of-pocket costs. There are also assistance programs you can reach out to for support.
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As a reminder, even FDA-approved medications come with side effects, and these drugs are no exception. In addition, these medications are relatively new in their use for weight loss and we can’t be quite sure about the long-term risks yet.
But if you want help working on your weight and wellness, learn more about safe and effective weight loss treatments.
This article originally appeared on Hers and was syndicated by MediaFeed.org.
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25 Weight-Loss “Tricks” You Should Stop Immediately
When it comes to diet and nutrition, we all want to find “the answer” that will fix our alleged problems. As a result, we often latch onto crazy diet ideas that, in the moment, sound like the perfect solution. But these too-good-to-be-true “solutions” can hurt more than help us in our attempts to achieve weight loss and gain healthy habits.
Here are some of the most common diet myths exposed.
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The protein-pushing keto craze sure makes it seem like carbs should be avoided at all costs. But do grains deserve their bad reputation?
“People often say that carbs are fattening,” says Kristin Kirkpatrick, MS, RD, LD. “But complex carbohydrates, like whole grains, are not ‘fattening’ foods.’”
In other words, avoid refined carbohydrates like white bread, rice and processed snacks, but keep those whole grains for a healthy balance.
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While diet sodas may be a better alternative than their full-sugar counterparts, medical studies are starting to show that the artificial sweeteners may actually cause us to eat more calories later in the day. If you want to keep the fizz and ditch the artificial sweetener, try flavored carbonated water instead.
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Like carbs, the type of fats we eat makes a difference. That, in combination with how many calories we eat each day, determines our body weight. Trans fats, typically found in many fried foods, can cause cardiovascular disease. However, saturated fats do not have the same effect and can, in fact, help keep us satisfied longer, leading to fewer calories consumed.
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Maybe you’ve only been eating the egg whites to avoid raising your cholesterol. Well, maybe you don’t have to anymore.
“Unless you are genetically predisposed to high cholesterol or cardiovascular disease, eating the eggs AND yolks can actually help you,” says Darin Hulslander, CEO and owner of DNS Performance and Nutrition. “For one, yolks are high in antioxidants, vitamins, and minerals. Egg yolks also elevate high-density lipoproteins, which are the ‘good’ proteins that can help remove plaque from the arteries.”
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If you count calories, you might think losing weight is as simple as staying under a certain number every day. Unfortunately, this is not necessarily true. You can eat 200 calories of lean protein or 200 calories of chocolate, but the body processes each differently. Depending on what you eat, your body can store or burn more calories. So, use those calories wisely!
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Reading headlines such as “red meat could lead to cancer” is frightening. And while some studies indicate there is an association with red meat consumption and cancer, it’s important to note that this doesn’t mean it causes cancer. Eating red meat in moderation is not dangerous.
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The American Heart Association recommends that people consume less than 1,500 milligrams of sodium (salt) each day. Excessive sodium can lead to high blood pressure. However, this doesn’t mean we have to eat bland food. Use salt in moderation and, if you have high blood pressure, talk with your doctor on the best guidelines for your individual needs.
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Sure, peanut butter is a good source of protein and fat. However, you need to be careful about what kind you put in your pantry. Many national brands of peanut butter are filled with extra sugar, fats and preservatives that counteract any health benefits. Check the label and pick up a jar with as few ingredients as possible to get the healthiest version of this favorite snack.
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Calories can’t tell time. The time of day of when you eat only matters if you tend to overindulge at the end of the day and eat too many calories. If you happen to eat a late dinner or snack but stay within your normal calorie range for the day, it should all even out in the long run. However, many people mindlessly eat at night because they are bored or tired, and this is what leads to weight gain.
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This is the one case where all calories are pretty much alike. Multiple studies show that eating the same amount of calories in either a few larger meals or more frequent smaller ones have the same outcome on the body. In other words, this is a case where 1,000 calories in a day are the same, no matter how often you eat during the day.
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With labels like “Lean Cuisine” and “Healthy Choice,” it’s easy to think that pre-packaged frozen meals are not only convenient but also a better choice to help us in our diet goals. This isn’t always the case. Many of these pre-packaged meals contain too much sodium, which can lead to water retention and bloat. Also, many offer too few calories, which can lead to hunger later on in the day. Check the labels carefully and make sure you’re making the best choice.
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When looking to avoid processed carbohydrates, many people reach for wheat or multigrain bread over white. But be careful! Make sure you’re picking up 100% wheat or whole grain bread. Otherwise, you could be just be getting mostly white bread with a little wheat flour mixed in — or even just food coloring to make it look brown!
Getty Images | Spencer Platt
This nutrition myth has been around forever, but it’s just not true for most people. Medical studies show that among extremely active people such as marathon runners and skiers, taking at least 200 milligrams of vitamin C every day can possibly cut the risk of getting a cold in half. But for most people, taking daily vitamin C did not seem to actually reduce the risk of getting a cold.
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Wouldn’t it be great if there were such a thing as a negative-calorie food? You know, the kind that burns more calories when we eat it than it has? Sadly, there is no such thing, even when it comes to something as healthy as a piece of celery.
“Regardless of the [calories] in the food, you’re always going to be able to get something out of it,” says Stephen Secor, a professor of biological sciences at the University of Alabama.
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Organic is simply how ingredients are grown, usually pesticide-, herbicide- and insecticide-free. An organic label does not mean it’s healthier than non-organic foods. Even things like sugar, granola bars and boxed mashed potatoes can be organic. So, don’t rely on an organic label to tell you if something is automatically better for your diet.
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While cutting out gluten from your diet can help if you have celiac disease, it isn’t really a factor in weight loss.
“Unless you suffer from celiac disease, there’s not much scientific support to back the claim that eating gluten-free is healthier or a smart strategy for weight loss,” says Ashvini Mashru MA, RD, LDN. “Cutting gluten out of your diet most often leads to a reduction in overall calories, simply due to the sheer amount of grain-based foods that we eat on a regular basis.”
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Fewer calories consumed means weight loss, right? Not so fast!
“In fact, studies have proven it to be the opposite: skipping meals promotes weight gain,” says Cheryl Forberg, RD, nutritionist for “The Biggest Loser.” “When we skip a meal, by the time we eat, we’re so hungry we consume too much, too fast and choose the wrong foods.”
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Foods like asparagus and lemons are known as natural diuretics. And while these kinds of foods may not hurt when it comes to holding onto excess water, eating large amounts of them will not help get rid of belly bloat or weight.
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Your daily cup of coffee may give you a good dose of caffeine, which is a stimulant to your body. However, that caffeine jolt does not boost your metabolism enough to be a weight loss cure-all. Also, depending on what you add to your coffee (cream, flavorings, sugar), you could be adding extra calories to your day. So if you love a cup of joe, keep it basic and black, if possible.
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This is a short-term fix with many long-term problems. By severely cutting daily calories for extended periods of time, your entire metabolism can change to actually hold onto weight! Also, your body needs adequate nutrition to stay healthy. If you want to lose weight and keep it off forever, you need a modest calorie restriction plan that you simply continue and never stop.
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You cannot outrun a bad diet. It’s as simple as that. Exercise is great for our cardiovascular health and for building good muscle tone. And yes, it does help regulate our weight. But the amount of exercise you have to do to counteract a few extra slices of pizza isn’t sustainable or reasonable. So work in a healthy diet plan along with your regular workouts for optimal results.
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In a pinch, these convenience items are helpful in maintaining a healthy diet. But things like shakes and nutrition bars are not meant to be long-term replacements for healthy meals. Check the ingredients for artificial sweeteners if you buy these items. Your best bet: Make these at home and use them occasionally.
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Yes, some people should probably cut back on sugar in order to make their diet healthier. But naturally sweet foods such as fruits are sources of important vitamins and minerals. The sweets to avoid are those with added sugars and syrups.
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Good news! While fresh vegetables are always a healthy option, so are most frozen varieties. Over time, fresh vegetables can lose nutrients, while frozen ones can retain them longer. Make sure you pick up frozen vegetables without added sauces, cheese or sodium to keep them as close to fresh as possible.
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Can you imagine life without ice cream, cookies or cake? You don’t have to in order to follow a healthy eating plan. In fact, planning to have some of your favorite treats occasionally can ensure you don’t feel deprived and end up splurging later on.
This article originally appeared on TheDelite and was syndicated by MediaFeed.
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