Marketplace plan coverage for weight loss treatment in Ohio
Plans sold on the Ohio marketplace are measured against one benchmark plan the state selected, and that document is public. The table below gives what it says about bariatric surgery, weight loss programs and nutritional counseling, with the line it says it in. Your own plan can still differ.
By the Covered Weight editorial team · Updated Aug 3, 2026. Research and sourcing by Evan Reid.
The document this page reads
Ohio selected Blue Access (PPO) - Standard Opt D55, a Small Group Market product from Community Insurance Company (Anthem BCBS), as its benchmark for plan years 2025 through 2027.
Ohio's Essential Health Benefits benchmark plan is the reference standard that individual and small-group health plans sold in the state are measured against. It is not any one reader's policy: an issuer may substitute benefits, and a plan's own documents decide what that plan pays for. It does not reach a self-funded employer plan at all, and most people with job-based coverage are in one, so a reader on an employer plan should read their plan document rather than this page.
State rules do not reach a self-funded employer plan. If your employer pays claims out of its own funds and hires an insurer to administer them, your plan document sets the rules and this page does not describe it.
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 from
Plan 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
What the benchmark says, benefit by benefit
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.
| Benefit | What the document says | The line it says it in |
|---|---|---|
| anti-obesity medication | Not publishedThe benchmark document does not address anti-obesity medication. Its prescription drug table lists every category and class the benchmark carries, including classes with a count of zero, and it prints no anti-obesity row at all. A class the document never lists is a class the document is silent on, which is not the same as a class the plan covers none of. The answer for one plan lives in that plan's own formulary.Ohio's EHB benchmark summary lists no anti-obesity drug class. Which prescription drug class does my plan use for weight-loss medication, and where is that plan's formulary published? Ask Health Insurance Marketplace Call Center, Centers for Medicare & Medicaid Services on 1-800-318-2596. | OHIO EHB BENCHMARK PLAN (2025-2027), PRESCRIPTION DRUG EHB-BENCHMARK PLAN BENEFITS BY CATEGORY AND CLASS Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromAnti-Addiction/ Substance Abuse Treatment Agents Alcohol Deterrents/Anti-craving 3 |
| bariatric surgery | Not coveredThe benchmark chart marks bariatric surgery not covered. That is a statement about this benchmark row. A plan sold in the state may still cover the service under a different benefit, and the plan's own documents decide. This is not an essential health benefit in the Ohio benchmark. "Directly related means that the treatment or surgery occurred as a direct result of, and would not have taken place in the absence of, the bariatric surgery. This exclusion does not apply to conditions including but not limited to: myocardial infarction; pulmonary embolism, thrombophlebitis, and exacerbation of co-morbid conditions during the procedure or in the immediate post-operative time frame. All medically necessary Basic Health Care services must be covered by an HMO plan. Complications from a non-covered procedure that require the need for any medically necessary Basic Health Care Service must be covered same as any other services." | OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Bariatric Surgery Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromBariatric Surgery No Not Covered No Bariatric surgery, regardless of the purpose it is "Directly related means that the treatment or surgery |
| weight-loss programs | Not coveredThe benchmark chart marks weight loss programs not covered. That is a statement about this benchmark row. A plan sold in the state may still cover the service under a different benefit, and the plan's own documents decide. This is not an essential health benefit in the Ohio benchmark. | OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Weight Loss Programs Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromWeight Loss Programs No Not Covered No |
| nutritional counseling | CoveredThe benchmark chart marks nutritional counseling covered and counts it as an essential health benefit. This describes the benchmark plan, not any one policy sold in the state. This is essential health benefit in the Ohio benchmark. Covered benefit under home health services and covered as USPSTF A or B recommendation under preventive health services (includes diet counseling for adults at higher risk for chronic disease, obesity screening and counseling for all adults, and healthy diet counseling for adults with cardiovascular risk factors). | OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Nutritional Counseling Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes fromNutritional Counseling Yes Covered No Covered benefit under home health services and |
What a benchmark plan is
Federal rules require plans in the individual and small group markets to cover ten categories of essential health benefits, and each state picks an existing plan as the reference for what those categories mean in that state. Weight loss treatment is not one of the ten categories, so whether it appears at all depends on the plan the state selected. That is why the answer changes at a state line for a benefit that has no federal floor.
When this page does not describe your plan
A benchmark reaches the individual and small group markets. If your employer pays claims out of its own funds, no state benchmark and no state mandate reaches your plan, and the plan document sets the rules instead. Most people with job-based coverage are in a plan of that kind, which makes it the most common way a reader takes the wrong answer from a page like this one. Weight loss coverage on a self-funded employer plan covers how to tell which kind you are on and what to ask for.
Reading a row that says the document is silent
A benchmark summary chart lists the benefits it addresses. When a benefit is not in the chart, the honest statement is that the document does not address it, and the row says so and names who can answer instead. It is not the same as an exclusion, and treating silence as a no is the mistake that makes most coverage tables in this field unusable.
Documents this page reads
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 from
Plan 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
Page 1 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. The summary block in document order, from the Plan Type line to the line before Supplemented Categories. OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Bariatric Surgery
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Bariatric Surgery No Not Covered No Bariatric surgery, regardless of the purpose it is "Directly related means that the treatment or surgery
Page 4 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Weight Loss Programs
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Weight Loss Programs No Not Covered No
Page 9 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. OHIO EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Nutritional Counseling
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Nutritional Counseling Yes Covered No Covered benefit under home health services and
Page 12 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. OHIO EHB BENCHMARK PLAN (2025-2027), PRESCRIPTION DRUG EHB-BENCHMARK PLAN BENEFITS BY CATEGORY AND CLASS
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Anti-Addiction/ Substance Abuse Treatment Agents Alcohol Deterrents/Anti-craving 3
Page 14 of the summary chart PDF. A neighbouring row, quoted because an absence cannot be quoted. The table prints a row for a class even when the submission count is zero, so a class the table never lists is a class the document does not address, rather than a class the benchmark carries none of. Runs of spaces collapsed to one.