Medicare adds coverage for obesity prevention

The federal Centers for Medicare & Medicaid Services (CMS) announced on 11/29/11 that Medicare is adding coverage for preventive services to reduce obesity. This adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act.

“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” said CMS Administrator Donald M. Berwick, MD. “It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

Over 30% of both men and women in the Medicare population are estimated to be obese. Obesity is directly or indirectly associated with many chronic diseases, including those that disproportionately affect racial and ethnic minorities such as cardiovascular disease and diabetes. Addressing the prevention of obesity related disparities has the potential to reduce obesity prevalence while also closing the gap on health disparities among Medicare beneficiaries.

Screening for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians’ offices are covered under this new benefit.

While public health professionals applaud CMS for a policy change that attempts to get at the root of obesity-related disease, some are concerned that primary care providers are not well qualified to effectively offer this counseling. Recent studies show that over 70% of primary care physicians have no training in weight-related issues. Obesity specialists also suggest that the benefit is too short-term to effective long-term change in the health patterns of older obese people who often have a long history of unhealthy habits.

The particulars of the new benefit include: For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling.