Covering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act

Abstract Background Currently, of the 51 State Health Exchanges operating under the Affordable Care Act, only 23 include benchmark plans that cover bariatric surgery coverage. Bariatric surgery coverage is not considered an essential health benefit in 28 State Exchanges and this lack of coverage has a discriminatory and detrimental impact on millions of Americans participating in State Exchanges that do not provide bariatric surgery coverage. Objectives We examined three State Exchanges in which a portion of their plans provided coverage for bariatric surgery to determine if bariatric surgery coverage is correlated with premium costs. Setting State Health Exchanges; United States Methods Data from the 2015 State Exchange plans were analyzed using information from Centers for Medicare & Medicaid Services’ (CMS) Individual Market Landscape file and Benefits and Cost Sharing public use files (PUF). Results Only three states (Oklahoma, Oregon, and Virginia) in the analysis have one or more rating regions in which a portion of the plans cover bariatric surgery. In Oklahoma and Oregon, the average monthly premiums for all bronze, silver, and gold metal levels are higher for plans covering bariatric surgery. Only one of these states included platinum plans that cover bariatric surgery. The average difference in premiums was between $1 to $45 higher in Oklahoma, and $18 to $32 higher in Oregon. Conversely, in Virginia, the average monthly premiums are between $2 and $21 lower for each metal level for plans covering bariatric surgery. Monthly premiums for plans covering versus not covering bariatric surgery ranged from 6% lower to 15% higher in the same geographic rating region. Conclusion Across all three states in the sample, the average monthly premiums do not differ consistently on the basis of whether the State Exchange plans cover bariatric surgery.