A regrettably self-conscious and media-pressured culture has resulted in millions of obsessive men and women who possess a mental illness that severely affects their physical health. While eating disorders can be paired with another type of psychological condition, they are themselves a dangerous, habit-forming and potentially life-threatening problem. The most common of these conditions are anorexia nervosa, bulimia nervosa and eating disorders otherwise not specified (EDNOS) such as binge-eating disorder, all of which fall under the mental illness category. Half of the individuals who have an eating disorder also qualify as having depression, and due to malnutrition and other negative effects on the body, eating disorders have the highest death rate of any mental illness.
Eating disorders are incredibly damaging to every aspect of a person’s health. An anorexic may experience long term effects such as organ failure, brain damage, osteoporosis, infertility, heart damage, fatigue and other traits. Individuals with bulimia may permanently erode their tooth enamel, develop a chronic sore throat and swollen neck and jaw glands, as well as severe dehydration and any number of gastrointestinal issues. Binge-eating typically leads to obesity, which has its own host of health problems, including immobility, damaged joints and ligaments, high cholesterol and high blood pressure.
Treatment for eating disorders is simple in theory, yet complex in application. Training these individuals to think and eat in a healthy way can involve heavy psychotherapy, constant medical care and monitoring, nutritional counseling and often medication. Some use the inpatient approach to resolve a severe problem. Now that health reform has established mental health care as an essential health benefit, meaning it’s covered in every state on exchanges, people with these illnesses can get treated for an affordable cost.
How Eating Disorders Affect Insurability: Past and Present
Health Reform & Eating Disorders
The Patient Protection and Affordable Care Act helps individuals with eating disorders by giving them the right to enroll in any health plan they choose on the individual market, unlike previously where only group plans would be available. Insurers must accept any applicants, even if they have health problems, and cannot issue exclusion periods or elimination riders to restrict a person’s coverage. In addition, the government provides tax credits given to those who need help paying premiums for coverage, which is now required under the individual mandate. To ensure plans provide enough covered services, each state will choose at least ten essential health benefits categories that all insurers must include. The health insurance exchanges in every state cover every category, including mental health care, allowing people to treat their illness with behavioral therapy and other types of care. Benefits vary by health plan, and though all exchange plans are required to include mental health, there may be differences from one to the next. Ask an agent for the specifics while you are applying.
Premiums also cannot be any higher for a person with an eating disorder. They can receive coverage for the same cost as a healthy person, regardless of health status or gender. Insurers will also not be able to increase premiums by a certain amount each year, as rates are regulated by the insurance department in each state. As for Medicaid, the program has expanded in some states, offering low-income childless adults free insurance.
Individual health insurance eligibility started with the BMI chart in most cases before health reform. Those who were a healthy weight would be accepted, and those who were over or under the recommended weight for their height would likely be declined. At times, a health insurance company would settle on a rate increase for those who are slightly overweight, but those who fall short of the minimum BMI would be rejected. Though it is seemingly unfair, as people with mental health problems need coverage, too, those who are at a higher risk of a wide variety of health issues were too much for an insurer to take on. Most eating disorders lead to a myriad of serious medical conditions, and if they had not been controlled prior to enrolling in a health plan, you were likely going to need coverage from a high-risk pool.
Health plans differed in their underwriting guidelines, though insurers were generally unanimous on declining malnourished individuals. Unless an applicant has reached a minimum BMI of 16, according to the underwriting criteria below, they would not be accepted. otherwise, the good news is that as long as you meet that minimum, this particular company will not penalize you with a rate increase. This also meant that even if you were accepted for coverage, the plan may refuse to cover treatment for your condition for a certain number of months. None of these actions are currently permitted in individual insurance under the ACA.
The chart below is an excerpt from the 2012 underwriting guidelines of a commonly purchased Florida health plan. It indicated whether there would be a premium increase or an immediate decline issued to an applicant. As children under age 19 were unable to be rejected for coverage, this particular carrier increased their normal premium by 150 percent if the child was underweight. If the applicant was or older, there is no luck getting on this policy. As these criteria are very black and white, and weight is the only measure of insurability, anyone with a history of an eating disorder over BMI 16 can pay a normal rate. Many other insurers also structured their underwriting according to an applicant’s height to weight ratio.
More Health Plans for Eating Disorders
Although most Americans will qualify for coverage on the individual market and the exchange, your options may also depend on income and employment. If your job supplies you with a substantial set of benefits, you will not qualify for a plan on the exchange, but you are always welcome to turn down your group plan and enroll in a private individual plan. If you earn up to the limits for Medicaid in your state, you may have access to free or low-cost health insurance through this program. CHIP is also available to families with children whose income is over the Medicaid limits, but still connects you with Medicaid providers and low copays.
If you are looking for condition-specific services through your health plan, you should always look at the schedule of benefits beforehand, as a plan through your workplace may not cover it. Low-income individuals have access to services based on their state’s Medicaid program. No health plan can turn you down or limit your coverage based on your health problems, however.
Group Health Plans
Employer coverage is the most commonly used form of health insurance in the nation, and if you have it available through your own job or your spouse’s, enroll away — after checking that it’s a good plan, of course. Look at the benefits and coverage details before you enroll. As an individual with a medical problem, group plans will not discriminate against you personally for coverage, as they cannot decline any workers. Private health plans vary from one workplace to another based on what your employer decides to provide. Typically, depending on your employer, these are comprehensive plans with major medical, preventive, primary and specialist care included.
Group health plans may also cover medically necessary treatment related to your condition, though it depends on the specific plan with which you are provided. Essential health benefits do not apply to group coverage, so mental health care is not mandatory for job-based plans. Consult your health plan for details on what types of care are covered before receiving treatment so you know which doctors to choose and how much it will cost.
Medicaid & CHIP
As eating disorders affect a large number of children and young adults, it is also important to know about Medicaid and the Children’s Health Insurance Program. If you and your family have a low income, this may be the health insurance plan for you. Anyone with a health condition is welcome to apply and will receive free coverage and free treatment through state and federal funding. CHIP usually is not entirely free, as the program accepts a higher income level of applicants. These programs cover mental health care, though each state has a slightly different approach.
Check your state‘s Department of Human Services for eligibility and benefit information. These programs are extremely beneficial to those who qualify, though like all insurance they do not cover everything. Certain medications may be excluded and require you to apply for a discount card. To ensure you get the care you need, speak with a benefits adviser at your local health department.
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1. NIMH. “Eating Disorders”. http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml.
2. ANAD. “Eating Disorder Statistics”. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/.