Turning 65 and Getting on Medicare? You Could Lose Coverage for Obesity Care

On Oct 24, 2024

For millions of people living with obesity, the class of weight-loss medications known as GLP-1 agonists have been game-changers (think Wegovy and Zepbound). Studies show that people on these medications can lose more weight than they can with just lifestyle changes alone.

But for one group of Americans — people on Medicare — at least some of these drugs have been off-limits because Medicare is not allowed to cover medications prescribed for the sole purpose of weight loss. With ample evidence that obesity itself increases numerous health risks and new indications that these drugs lower risks of heart disease and stroke, those limits may be changing.

A bipartisan bill, the Treat and Reduce Obesity Act (TROA), moving through Congress would allow Medicare to cover weight-loss medications for the first time.

Experts argue it’s about time.

“The passage of the Treat and Reduce Obesity Act (TROA) is crucial for protecting women’s access to obesity care as they transition to Medicare,” said Fatima Cody Stanford, M.D., M.P.H., M.P.A., associate professor of medicine and pediatrics at Harvard Medical School and obesity medicine physician-scientist in the Massachusetts General Hospital Weight Center.

Stanford explains that TROA improves comprehensive coverage while improving equitable access to care.

“The TROA aims to expand Medicare coverage to include a wider range of obesity treatments, including FDA-approved medications and intensive behavioral therapy. This ensures that women can continue their established treatment regimens without interruption,” she said. “The TROA addresses disparities in healthcare access, ensuring that all women, regardless of their financial situation, can receive the necessary treatments to manage their obesity effectively.”

The costs of obesity

For 31 million women over age 65 (and another 4 million younger women who qualify for Medicare because of long-term disabilities), Medicare’s lack of obesity care coverage creates risks. Approximately 10,000 Americans turn 65 every day, more than half of whom are women. With obesity rates reaching 43% in people over age 60, losing access to obesity treatments can be especially detrimental.

“When women transition from private insurance to Medicare at the age of 65, they often face a significant loss in coverage for obesity treatments,” Stanford said. “When women who have been receiving consistent obesity treatment, including medications, behavioral therapy and nutritional counseling, experience an abrupt halt in their care, this can lead to weight regain and worsening of obesity-related conditions.”

Experts recognize obesity as a chronic medical condition. According to the CDC, 2 out of every 5 American adults are living with obesity. Almost 6 out of 10 of them also have high blood pressure, which raises their risks for heart disease. Nearly 1 out of 4 also have diabetes. Obesity is also known to increase the risks of certain cancers, pregnancy and fertility problems, and mental health issues, among other conditions.

“Obesity is a chronic disease that requires ongoing management,” said Alicia Shelly, M.D., obesity medicine physician. “Without Medicare coverage for obesity treatment, women are at increased risk for serious health issues like heart disease, diabetes and cancer. Long-term support is essential to help prevent these life-threatening conditions.”

Obesity is also a serious economic issue. People with obesity have nearly $2,000 more in annual medical costs than people without obesity. Overall, those costs add up to nearly $173 billion in extra medical costs each year in the U.S.

And that’s just direct medical costs associated with obesity. Add to that lost productivity that results when employees miss work, are less productive at work due to obesity complications, or prematurely die or leave the workforce due to disability. The CDC estimates that obesity-related missed work alone costs between $3.38 and $6.38 billion each year.

TROA is one way to reduce these costs.

“By providing coverage for obesity treatments, the TROA supports preventive health measures, reducing the incidence of obesity-related diseases and lowering long-term healthcare costs,” Stanford said.

In women’s own voices

In a HealthyWomen survey of 1,000 women ages 35 to 64, nearly one-quarter reported having been diagnosed with obesity, and 79% said they were trying to lose weight or lower their BMI. Another 8% of respondents said they are caregiving for someone living with obesity.

Nearly two-thirds of women living with obesity reported dieting or considering doing so, and one in five said they’re taking or considering taking an anti-obesity medication (AOM).

The survey results show that 8 out of 10 women who consult a nutritionist said their insurance covers all or part of those costs, but only 6 out of 10 said the same about insurance coverage for AOMs.

Women living with obesity said that achieving their desired weight would have the biggest positive impact on their physical and mental health, self-confidence, and daily activities. But 11% of survey respondents who reported that they will turn 65 in the next six months (or are caregiving for someone who will) will not have access to AOMs under the current rules. Seven percent of women said they have a plan that will no longer cover their AOM next year or that they’re caring for someone in that situation.

The survey also revealed racial and ethnic health disparities. Nearly one-third of respondents said they have been diagnosed with obesity or would be if they went to a healthcare provider (HCP) who would assess their weight. And Black respondents were twice as likely than Hispanic/Latina respondents to categorize themselves this way.

Insurance status also showed important differences. People on Medicaid, the public insurance program for Americans with lower incomes, were more likely to say they had been diagnosed with obesity (31%) compared with 20% of those with job-based insurance and 17% with other private coverage. Among survey respondents with Medicare coverage, 13% said they care for someone with obesity and 26% are living with obesity.

Fighting for coverage

“The sudden lack of support and resources can have a detrimental effect on mental health, leading to feelings of helplessness, frustration and depression,” Stanford said. “This can further exacerbate the challenges associated with managing obesity.”

Stanford recommends that women transitioning onto Medicare be proactive about their care, such as reviewing various Medicare plan options to find the most comprehensive obesity coverage available and/or adding supplemental coverage (known as Medigap). She also recommends consulting HCPs to plan for the transition in advance and get their help navigating coverage or finding alternative treatments.

“I recommend developing a plan that outlines the available and affordable obesity treatments,” Shelly said. “Currently, Medicare does not cover weight loss medications, so it’s important to prioritize optimizing your nutrition and physical activity to support weight maintenance.”

More broadly, anyone who is or may someday be covered by Medicare can use their voice to advocate for coverage. Write letters to elected officials, call or visit their offices, or even request meetings to express support for TROA.

“Stay informed about legislative changes like the Treat and Reduce Obesity Act and advocate for their passage,” Stanford said. “Engaging with patient advocacy groups can amplify your voice and help drive policy changes.”

This educational resource was created with support from NovoNordisk, a HealthyWomen Corporate Advisory Council member.

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