An increasingly prevalent health concern in our country, obesity is a difficult issue when it comes to health insurance. According to BMI charts used in the underwriting process, being over a certain height to weight ratio is worthy of automatic decline. This is due to the high cost of paying for medical care when a person’s weight is likely to cause a domino effect of damage if they do not get themselves to a healthy range. It is also a hard condition to treat, as we see thousands more adults in every state expanding the population of those considered obese.

Having a body mass index over 30 earns a person obesity status, as a healthy BMI is considered between 18.5 and 24.9. A recent study projects that 42 percent of all Americans will be obese by 2030, 11 percent of which will be over 100 pounds overweight, by that time. Currently, one-third of all adults in America are obese, and 17 percent of adolescents. Obesity can lead to a number of serious and life-threatening health problems, including type 2 diabetes, high blood pressure, high cholesterol, gallstones, coronary artery disease, stroke, and sleep apnea, among others.

Obesity also has an impact on employee effectiveness, and therefore our economy. Reportedly, obese men take nearly 6 more sick days per year and obese women take 9.4 more sick days in a year than healthy workers. As a result, it has cost companies up to $6.4 billion per year. Illness resulting from obesity has also proven a lack of productivity among employees, as they cannot physically keep up with their jobs.


Finding a Health Plan

Despite the fear of being declined coverage, there are health insurance options for the obese. If you have been rejected for insurance or are worried you likely will be, call one of our agents and ask us about your options at 888 803 5917. However, you may not always be declined for coverage and receive a rate increase instead. Though this may not sound appealing, depending on the estimated cost the insurer provides, it may not be so harsh. Each company varies with how they handle obesity, or any other health condition. Below is a chart from a national insurer’s underwriting risk criteria in regards to obesity.

“IC” stands for Individual Consideration, meaning each case is treated according to the applicant’s risk level. The applicant needs to be assessed and have more factors taken into consideration, then it will be decided if they are approved or declined. This usually results in a rate increase that corresponds with the individual’s health and lifestyle. “D” is an automatic decline for coverage, disqualifying an applicant for the plan completely.

Condition Risk Criteria Risk Level with Approximate % Increase


Besides an individual health plan or group insurance through your employer, people with a BMI over 30 can receive benefits through Medicaid, if they have a low income, or the Pre-Existing Condition Insurance Plan (PCIP). PCIP acts as a temporary high-risk pool until the health care law goes into effect in 2014, and members pay premiums, deductibles, and fees for their care. Medicaid is free coverage for those who do not earn enough to pay for their own insurance, and meet certain income guidelines. They accept anyone regardless of their health condition and pay for services to help them get well through participating Medicaid providers.


Treatment Costs and Concerns

The costs of obesity are immense, and as the Affordable Care Act is about to allow obese persons to receive health benefits on equal terms with healthy ones, our nation is bracing itself for a large deficit. In the current state of health insurance, premiums increase in order to compensate for the amount of care being delivered. If all of these people with chronic health problems due to their weight flood the health care system, health care and insurance will have a drastic price increase for everyone.

A study published in the Journal of Health Economics discovered that the average spending for an obese person on health care was $3,721 per year, as opposed to $512 for someone of a healthy weight. Therefore, an estimated $190 billion is being spent every year on health care due to obesity, which is 20.6 percent of the nation’s annual medical expenses. Some of these costs are paid for by non-obese taxpayers whose funds go towards Medicaid and other public health programs.

Also by paying higher premiums, insured Americans are paying for the health care system to deliver care to obese individuals. Someone has to pay for it. Costs in health insurance and health care are balanced in such a way that care can be provided to those in need. As individuals who are insured partially pay for emergency care for the uninsured, or people who do not smoke contribute to medical expenses for those who do, the balance requires a bit of irony.



In an attempt to tame the massive amount of health care spending on obesity, the Affordable Care Act has established a penalty system for those using an employer-sponsored health plan. Now, employers can issue penalties for workers who do not participate in recommended wellness programs. In certain instances, they can also give workers a penalty for not meeting health goals, such as a healthy body mass index. If an employee is at risk, they are likely to pay a penalty for not doing anything to change.

The ACA increased the limit on the amount that can be charged for a penalty, in order to truly intimidate workers to be interested in health incentives. Rewards programs through group coverage are quite common, and start with a health risk assessment, then the employee responds to their evaluation by joining a fitness center, managing their diabetes, or learning to eat nutritiously. Some rewards include discounts on health-related items and services, and others are rewarded by not receiving a penalty.

However, employers may have to be prepared to make adjustments and set up a more comprehensive treatment plan, not leaving it up to personal responsibility alone. Many employers view health issues as a personal responsibility, and are not likely to change their minds. Encouraging those who are dangerously overweight to change their lifestyle is a positive move, and the health care law is attempting to inch towards affordability for everyone.