Health Insurance for Overweight Applicants

TN | April 11, 2005


Summary: In the past overweight applicants had difficulty finding good health insurance at standard rates. Fortunately, being overweight is no longer an insurmountable obstacle to finding affordable health insurance. A handful of high quality insurance plans are now available to most Americans without regard to weight and more will be introduced in the near future. Three of the policies listed in this article are major medical insurance and three are limited benefit plans. Each type of coverage has its own advantages and disadvantages. Health care and health insurance are certainly costly, but the insurance plans listed here fall into the more "affordable" category of coverage, with almost all plans priced at less than $500 per month. Because insurance availability is governed by state law, the available choices are based on residence at the time of application. All insurance plans listed provide nationwide protection with any doctor or hospital of your choice.

One in fifty adult Americans is clinically obese, according to a recent Rand study. A clinically obese person is one who is more than 100 pounds overweight. These large people require extraordinary medical care that few medical facilities are equipped to handle. Most medical offices do not have scales to weigh patients over 300 pounds despite the fact that accurate weight is crucial to prescribing many types of medicines. These patients may not fit on normal hospital beds, imaging equipment, wheelchairs or operating tables. Severely overweight people are far more likely to suffer from diabetes, arthritis and other medical conditions.

The nation is slowly changing its attitude toward obesity as a medical condition. The IRS now allows the cost of weight loss programs to be deducted by taxpayers as a normal medical expense. Employee benefit plans may now classify weight control costs as a tax-free benefit under a health plan. The state of new Louisiana launched a study to examine the financial effects of gastric by-pass surgery on the overall health care costs of obese patients. If the results of this study are favorable, we might expect to see gastric bypass treatment routinely covered procedure under health insurance plans that are defined to cover ordinary and necessary medical expenses.

For years health insurance companies have charged extra premiums to overweight members. In those cases where severe obesity is accompanied by full or partial disability, unemployment or underemployment, the high cost of these health insurance plans is unaffordable. Some health plans are simply not available to applicants who weigh more than allowed by the underwriters.

In small business health insurance plans, insurance is always available to every full-time employee regardless of weight or medical history. The extra cost of caring for overweight members is spread evenly among all of the employees of the business. Adding an obese employee can boost the premium cost by 5% to 25% for everyone in the group and may cause resentment among the lighter weight employees. Even in larger groups and Blue Cross plans that use a one price for all the high cost of treating obesity has become a politically charged issues.

This article assumes that group insurance, COBRA coverage or similar types of conversion coverage are not available or have been ruled out due to the high cost. While these policies almost always provide the best coverage for pre-existing medical conditions, the cost and availability frequently a pose a problem. As a result, most people searching online for health insurance are seeking an alternative type of policy. It is important to remember that a lower policy cost means that coverage is limited in some manner.

All of the following low cost health insurance plans are available without regard to the applicant's weight:

The best low cost health insurance option, where available, is often Secure 3x12 STM, a comprehensive major medical insurance with a good consumer reputation that will be issued at standard rates and does not screen for weight. It provides continuous coverage for up to 36 months and re-application is allowed for another 3 years, etc. Obese applicants are approved at standard rates without any extra charge. Higher deductible policies are available to keep premiums affordable. The only downside is that pre-existing conditions are not picked up from one policy to the next. At this time, this insurance is currently available only in Alabama, Arizona, Delaware, D.C., Florida, Georgia, Hawaii, Illinois, Missouri, Nebraska, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Virginia, Wisconsin, and Wyoming. A shorter version of the policy is available in other states. More information can be found at http://www.medsave.com/articles/Review-of-Secure-12x3-STM.htm.

In most states the American Health Shield or Simple STM policies (both available at www.MedSave.com) offers full protection and can be issued at standard rates without regard to weight. Coverage always issued at standard rates because the application does not ask about the applicant's weight. This coverage plan is unavailable to individuals with diabetes (that often accompanies obesity) and to those who have previously been declined for coverage. The primary limitation is that this plan requires re-enrollment every six months and pre-existing medical conditions are not covered.

When weight is not the only medical issue, Core Health Insurance is the most popular limited benefit health insurance choice. This insurance is available throughout most of the United States. This is not major medical insurance but rather a specified benefit insurance that is designed to provide a reasonable level of protection at an affordable price to everyone regardless of medical history. There are no medical questions on the application, nor any restriction on weight. The insurance provides the most liberal coverage for pre-existing medical conditions, For these reasons, Core Health Insurance is usually the best choice when other medical conditions accompany the weight issue. A detailed review is published at http://www.medsave.com/articles/Review-of-Core-Health-Insurance.htm. The primary advantage of supplemental health insurance is that it may be combined with any other type of insurance to increase overall coverage. Benefits may be paid to you in cash or to the medical provider. Because of its wide range of pricing options and coverage, Core Health Insurance is often the most comprehensive limited benefit insurance (oxymoron intended) when major medical insurance is not available.

Value Med Insurance is available in all states except CT, KS, MN, NC, ND, NJ, NY, RI, VT and WA to applicants under age 65 without regard to weight. This limited benefit coverage focuses on outpatient services but the medical eligibility is very liberal. This insurance pays expenses for pre-existing medical conditions after the policy has been in force for 12 months. This is a limited benefit insurance policy that pays a specific dollar amount that is less than the amount charged by a medical provider. The policy is renewable until age 65. Maximum benefits, premium rates and enrollment form are included in the enrollment kit.

Another final option is Basic Health Insurance, a low cost minimal benefit policy that is available to everyone under age 70 in approved states without regard to weight. This insurance is currently available in AK, AL, AZ, DC, DE, GA, HI, IA, IL, IN, KY, MI, MO, MS, MT, ND, NE, OK, PA, RI, and SC. This insurance does not cover catastrophic medical bills, but pays a specific list of charges with no deductibles or co-payments. One advantage of this plan is that it pays for costs associated with pre-exiting medical conditions after the policy has been in force for six months. This policy is best combined with other health insurance since it pays cash benefits in addition to any other insurance that is available.

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