Marketplace weight loss coverage, state by state
Each state picked one benchmark plan, and plans sold on that state marketplace are measured against it. This table gives what each of those documents says about bariatric surgery, weight loss programs and nutritional counseling, with the line the answer was read from. None of the charts read so far prints a line for the drugs themselves.
By the Covered Weight editorial team · Updated Aug 3, 2026. Research and sourcing by Evan Reid.
What each benchmark plan says
What each label means
- Covered
- On the benefit, with no gate in front of it.
- Covered with conditions
- On the benefit once a requirement is met first.
- Depends on your plan
- Your own plan document decides. No state rule reaches it.
- Not covered
- The document says no. Read the note for whether an exception exists.
- Not published
- We looked and nothing is published. The cell names who to ask.
| State | anti-obesity medication | bariatric surgery | revision surgery | weight-loss programs | nutritional counseling | The chart it was read from |
|---|---|---|---|---|---|---|
| California | Not published | Covered | No record | Covered | Not covered | CALIFORNIA EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromPlan Type Small Group Market Issuer Name Kaiser Foundation Health Plan Inc. Product Name Small Group HMO Plan Name Small Group HMO 30 |
| New York | Not published | Covered | No record | Not covered | Not covered | NEW YORK EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromPlan Type Small Group Market Issuer Name Oxford Health Insurance, Inc. Product Name EPO Plan Name Oxford EPO |
| Ohio | Not published | Not covered | No record | Not covered | Covered | OHIO EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromPlan Type Small Group Market Issuer Name Community Insurance Company (Anthem BCBS) Product Name PPO (Blue Access PPO) Plan Name Blue Access (PPO) - Standard Opt D55 |
| Texas | Not published | Not covered | No record | Not covered | Not covered | TEXAS EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromPlan Type Small Group Market Issuer Name Blue Cross Blue Shield of Texas Product Name Blue Choice PPO Plan Name Blue Choice PPO RSH3 |
4 jurisdictions are published so far. A state joins this table in the same change that publishes its pages, so a row here always means its record has been through the same gates as everything else on the site.
What this table can and cannot tell you
It tells you the floor your state set. It does not tell you what your plan pays. An issuer may substitute one benefit for another of the same value, a plan may require prior authorization the chart never mentions, and a self-funded employer plan is not measured against a state benchmark at all, which covers most people with job-based coverage.
If you want the answer for your own plan, the question to settle first is which document governs it. That is a different question from this one and it has its own page.
Start by finding out which document governs your plan
Everything else follows from it. A state program publishes its own rules. A marketplace plan is measured against a state benchmark. An employer plan that pays claims out of the employer's own funds sets its own rules, and no state rule reaches it.
Common questions
Does the benchmark plan decide what my plan covers?
No. A benchmark plan is the reference standard a state selected, and it sets a floor for plans sold on that state marketplace. An issuer may substitute benefits, a plan may add its own prior authorization rules, and a self-funded employer plan is not reached by it at all. Your own plan documents decide what your plan pays.
Why does every state say the drugs are not published?
Because the benchmark summary chart does not print a line for anti-obesity medication. That is a gap in the published document rather than an exclusion, and reporting it as a ninth status is the honest reading. Whether a marketplace plan pays for the drug lives in that plan formulary, not in the benchmark chart.
Two states show the same answer. Is one of them wrong?
No. Most states landed on the same treatment of these four benefits, which is why this is one table rather than a page for each state. Twenty-one of the fifty records read so far carry the identical combination of statuses.
Where does each answer come from?
Each row cites the benchmark summary chart the state published, by document title and the line the status was read from, with the date it was read. Follow the badge in the row to see it.