Title: HSA Eligibility: The Group Weight Loss and Wellness Program
The Lifestyle Medicine Maine Group Weight Loss and Wellness Program is a Medically Facilitated diet and lifestyle change program that is currently available to Maine State Residents. The Group Weight Loss and Wellness Program focuses on weight loss and reversal of chronic medical conditions like:
Obesity (defined as a BMI of 30 or more)
Prediabetes
Type 2 Diabetes
High Blood Pressure (Hypertension)
High Cholesterol (Hyperlipidemia)
Osteoarthritis by addressing chronic systemic inflammation measured through hs-CRP
Sleep Apnea (OSA)
Chronic Heart Burn (Gastroesophageal Reflux Disease [GERD])
Non-alcoholic Fatty Liver Disease (NASH)
Can I use my HSA to pay for the Group Weight Loss and Wellness Program? Like all things insurance, it depends. Today we are going to chat about who/what qualify's.
Who can use their HSA funds for the Group Weight Loss and Wellness Program? Here are the key questions to ask:
Do we have commercial insurance or government insurance (MaineCare/Medicare/Medicaid)? AND
Do we have a weight-related medical condition?
If we have commercial insurance AND a weight-related medical condition, then we can likely use our HSA for the Group Weight Loss and Wellness Program here at Lifestyle Medicine Maine.
If we do not have a weight-related medical condition OR we have government insurance like MaineCare, Medicare or Medicaid, then we are likely not eligible to use our HSA funds.
Let's dive further into the fine print.
Health Savings Accounts (HSA). The IRS defines HSA eligible purchases for commercial insurance programs, irregardless of which commercial HSA provider we use. According to the IRS, we can't used our HSA fund for "the cost of a weight-loss program if the purpose of the weight loss is the improvement of appearance, general health, or sense of well-being. You can't include amounts you pay to lose weight unless the weight loss is a treatment for a specific disease diagnosed by a physician" (1, p16).
So, if we have a weight-related medical condition, and we have commercial insurance, then we can use our HSA as long as we submit a letter of medical necessity for the program (which our clinician here at Lifestyle Medicine Maine can provide).
What qualifies as a weight-related medical condition? Medical conditions that are related to overweight and obesity include:
A diagnosis of Obesity (BMI of 30 or above)
Prediabetes
Type 2 Diabetes
Hyperlipidemia (high cholesterol)
Hypertension (high blood pressure)
Obstructive Sleep Apnea (OSA)
Gastroesophageal Reflux Disease (GERD) aka diagnosed Heart Burn
Osteoarthritis
Fatty Liver Disease
What about MaineCare, Medicare or Medicaid? Medicare and Medicare part B patients are unfortunately not eligible to use HSA/FSA funds because the provider at Lifestyle Medicine Maine has had to opt-out of the Medicare system. Lifestyle Medicine Maine programs are fully out of pocket for MaineCare, Medicare and Medicaid patients.
How can we determine if we can use our HSA? The easiest way to answer this question is to call our HSA/FSA provider. The number is typically on the back of the card. Please reach out to our clinician, Jessica Krol, FNP, DipACLM here at Lifestyle Medicine Maine if you would like to request a letter of medical necessity or if you would like assistance to determine if you are eligible to use your HSA or FSA dollars.
Important note: even with a letter of medical necessity, sometimes claims can get denied. Lifestyle Medicine Maine cannot guarantee reimbursement for services/programs purchased with HSA funds.
References
Medical and Dental Expenses: Publication 502 for use in preparing 2023 returns. Department of the Treasury Internal Revenue Services (IRS). (12/21/2023) https://www.irs.gov/pub/irs-pdf/p502.pdf#page=13.10
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