Treat and Reduce Obesity Act (TROA): What It Means for Medicare Beneficiaries

Table of Contents#

1. What Is the Treat and Reduce Obesity Act (TROA)?
2. Current Medicare Obesity Coverage: Key Gaps
3. Core Proposed Changes in TROA
4. Who Benefits From TROA?
5. Expected Clinical and Financial Impacts
6. 2024 Legislative Status of TROA
7. Next Steps for Beneficiaries and Advocates
8. References

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1. What Is the Treat and Reduce Obesity Act (TROA)?#

First introduced in Congress in 2012, TROA is a bipartisan bill reintroduced in every legislative session since, with support from both Democratic and Republican lawmakers. Its core mission is to amend the Social Security Act to recognize obesity as a chronic disease under Medicare rules, and expand access to evidence-based, multidisciplinary weight management care for the 65 million Americans enrolled in Medicare.

The bill is endorsed by more than 100 national health and aging organizations, including the American Medical Association, American Heart Association, Obesity Society, and AARP.

2. Current Medicare Obesity Coverage: Key Gaps#

As of 2024, Medicare only covers one form of obesity care: Intensive Behavioral Therapy (IBT) for Obesity. This benefit includes:

• 15-minute weekly counseling visits with a primary care provider (PCP) for the first month
• Biweekly visits for the next 5 months
• Monthly maintenance visits for an additional 6 months, only if a beneficiary loses at least 3 pounds in the first 6 months of care

This limited benefit leaves massive gaps for patients:

1. No coverage for FDA-approved anti-obesity medications (AOMs): Medicare Part D explicitly excludes coverage for weight loss medications, even when prescribed by a provider for chronic weight management. Most AOMs cost $1,000 to$1,600 per month out of pocket, putting them out of reach for 90% of Medicare beneficiaries.
2. No coverage for multidisciplinary care: IBT can only be delivered by a PCP, so care from registered dietitians, obesity medicine specialists, exercise physiologists, or mental health providers for weight management is not covered.
3. No coverage for community-based programs: Medically supervised community weight management programs (e.g., medically tailored WW, hospital-run community weight loss groups) are not covered, even when recommended by a provider.
4. Limited access for rural and low-income beneficiaries: Only 1% of eligible Medicare enrollees currently use the IBT benefit, per CMS data, due to lack of PCPs trained in obesity care, particularly in rural areas.

3. Core Proposed Changes in TROA#

TROA addresses these gaps with four landmark policy changes:

3.1 End the Medicare Part D exclusion for anti-obesity medications#

The bill would amend the Social Security Act to allow Part D and Medicare Advantage plans to cover FDA-approved AOMs prescribed for chronic weight management, for beneficiaries with:

• A body mass index (BMI) of 30 or higher, or
• A BMI of 27 or higher with at least one weight-related comorbidity (e.g., type 2 diabetes, hypertension) This aligns Medicare coverage with FDA labeling requirements for all currently approved AOMs.

3.2 Expand coverage for multidisciplinary obesity care#

TROA would allow Medicare to cover coordinated obesity treatment plans delivered by a range of licensed providers, not just PCPs, including:

• Board-certified obesity medicine specialists
• Registered dietitian nutritionists
• Exercise physiologists
• Mental health providers (to address underlying psychological drivers of weight gain)
• Telehealth providers, to expand access for rural and homebound beneficiaries

3.3 Cover evidence-based community weight management programs#

The bill would add coverage for medically supervised community weight management programs, removing the requirement that all obesity care be delivered in a clinical setting.

3.4 Reduce administrative barriers to care#

TROA eliminates mandatory prior authorization requirements for covered obesity care, reducing administrative burdens for both providers and patients.

4. Who Benefits From TROA?#

• 26 million Medicare beneficiaries with obesity: 40% of all Medicare enrollees meet the BMI criteria for covered care under TROA.
• Beneficiaries with obesity-related comorbidities: More than 70% of Medicare enrollees with type 2 diabetes, 60% with heart disease, and 55% with osteoarthritis have obesity, and would see improved access to care that slows progression of their conditions.
• Rural and low-income beneficiaries: TROA’s telehealth and community program provisions would expand access to care for groups that currently have the lowest rates of access to obesity treatment.
• Healthcare providers: The bill reduces administrative hoops and gives providers a full suite of evidence-based tools to support their patients’ health.

5. Expected Clinical and Financial Impacts#

Clinical Impacts#

Research from the Obesity Society shows that combining behavioral therapy, AOMs, and multidisciplinary support leads to average total body weight loss of 10-15% for most patients, compared to just 3-5% for behavioral therapy alone. This level of weight loss reduces risk of type 2 diabetes progression by 58%, heart attack risk by 20%, and joint replacement need by 32% for adults with obesity.

Financial Impacts#

While opponents have raised concerns about short-term costs of AOM coverage, independent analyses from the University of Southern California and the Bipartisan Policy Center estimate TROA would save Medicare $12 to$15 billion over 10 years by reducing costly hospitalizations, emergency department visits, and surgeries for obesity-related conditions.

Equity Impacts#

TROA would reduce racial and ethnic health disparities: Black and Hispanic Medicare beneficiaries have 15-20% higher rates of obesity than white beneficiaries, and are less likely to be able to afford out-of-pocket AOM costs.

6. 2024 Legislative Status of TROA#

As of mid-2024, TROA has been reintroduced in the 118th Congress with:

• 172 bipartisan cosponsors in the U.S. House of Representatives
• 34 bipartisan cosponsors in the U.S. Senate The bill was advanced out of the House Energy and Commerce Committee in July 2023, and is waiting for a full vote on the House floor before moving to the Senate for consideration.

7. Next Steps for Beneficiaries and Advocates#

If you support TROA, you can take action to move the bill forward:

1. Look up your elected officials’ cosponsorship status on Congress.gov by searching for "Treat and Reduce Obesity Act".
2. Contact your House Representative and two Senators via phone, email, or in-person meetings to voice your support for the bill.
3. If you are a Medicare beneficiary, talk to your provider about your weight management goals now, to create a care plan you can implement if TROA passes.
4. Follow updates from advocacy groups including the Obesity Action Coalition and AARP for breaking news on the bill’s progress.

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References#

1. Centers for Disease Control and Prevention. (2023). Adult Obesity Prevalence in the United States. Retrieved from https://www.cdc.gov/obesity/data/adult.html
2. Centers for Medicare & Medicaid Services. (2024). Obesity Intensive Behavioral Therapy Benefit. Retrieved from https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/obesity-behavioral-therapy
3. Congress.gov. (2024). H.R.2519 - Treat and Reduce Obesity Act of 2023. Retrieved from https://www.congress.gov/bill/118th-congress/house-bill/2519
4. The Obesity Society. (2023). Treat and Reduce Obesity Act (TROA) Fact Sheet. Retrieved from https://www.obesity.org/policy-advocacy/treat-and-reduce-obesity-act
5. Bipartisan Policy Center. (2022). The Fiscal and Health Impacts of Expanding Medicare Coverage for Obesity Treatment. Retrieved from https://bipartisanpolicy.org/report/expanding-medicare-obesity-treatment-coverage/
6. AARP. (2023). AARP Supports the Treat and Reduce Obesity Act. Retrieved from https://www.aarp.org/politics-society/advocacy/info-2023/treat-and-reduce-obesity-act-support.html