Severe ankle pain drove Jelon Smart to start taking a weight loss injection a year and a half ago.

Smart was 285 pounds and worked as a caterer in Savannah, Georgia. After she’d been standing on her feet for long hours, her ankles would be “as swollen as a football,” she said. She was walking with a limp. An orthopedic doctor diagnosed her with Achilles tendinitis and recommended losing weight to mitigate the symptoms. Smart began taking the brand-name GLP-1 Ozempic.

The appetite suppression resulted in her shedding pounds quickly, at first.

“I lost 30 pounds initially without changing anything,” said Smart, 48. But then she found herself unable to shed additional pounds.

GLP-1s have quickly become one of the most popular types of weight loss drug in America. Nearly 1 in 5 people have taken them at some point, , a health information nonprofit that includes ºÚÁϳԹÏÍø News. But doctors say it takes more than a regular shot for patients to achieve their weight goals in the long run.

Here’s what to know.

The Old-School Rules of Weight Loss and Health Still Apply

Regular exercise, smart food choices, plenty of sleep — those basic, healthy lifestyle choices are not only going to help you lose weight on a weight loss drug but also help you keep it off, said Dafina Allen, an  obesity medicine physician who runs a clinic in Saginaw, Michigan. For example, some people find that they eat less on a GLP-1, “but they’re not improving their health because they’re not exercising. They’re not improving the quality of the food they’re eating,” Allen said. The path to weight loss is also guided by hormones, metabolism, and genetics.

After her weight loss on Ozempic plateaued, Smart realized she needed to start moving her body, too.  “I’m in the gym now six days a week,” she said. “I went from 285 to 175” pounds. The swelling and pain in her ankle went away as well.

Mental Health Matters, Too

The mind and body are deeply connected. Food and body image can be especially emotional, Allen said. “I can tell you about the patients that I helped lose 50 pounds, that I helped lose 100 pounds, and they still look in the mirror and are not happy.”

The key is seeking help for mental health along the way, said Gerald Onuoha, who practices internal medicine in Nashville, Tennessee. “Making sure that you’re talking to people about your problems, whether it’s a family member or a licensed professional, I think goes a long way,” he said.

Work With a Doctor To Closely Monitor Your Dosage

Onuoha said people can run into serious problems if they increase their GLP-1 dosage too quickly or don’t follow the recommended schedule. He’s seen patients come to the hospital with pancreatitis, gallstones, or acute kidney injury.  “I always ask patients that are on GLP-1s: How long have they been on them?” he said. “Are they adhering to the directions? Because those things determine whether or not you’re going to have those complications.”

Part of the issue, Allen said, is that GLP-1s are relatively easy to access — and often much cheaper — through online pharmacies or websites, but those providers may not educate patients about their dosage or side effects. “So they might just go online, find a random company that will ship it to their house, where they don’t even know what dose of the medication they’re taking, or even if the medicine is safe for them as the patient with the medical conditions they have,” she said.

People and Policy

GLP-1 drugs can be costly, and most insurance programs — public or private — don’t cover the medications for weight loss. Medicaid, the government program that covers 69 million Americans, covers GLP-1s for medically accepted conditions like diabetes, but only about a dozen state Medicaid programs cover GLP-1s for obesity treatment, . For older Americans with Medicare, the federal government is planning to allow temporary coverage of GLP-1s for weight loss starting in July.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ºÚÁϳԹÏÍø News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

When Mike McKee thinks about saving money for the future, he has a few priorities. Maxing out his retirement is one. Building up his kid’s college fund is another.

Opening up a health savings account? Not so much, even though he qualifies because of his high-deductible health plan.

“I’m so frustrated with the system that has anything to do with medical savings,” said McKee, 42, a self-employed musician in Nashville, Tennessee. “I’m just so turned off emotionally that I have to be really careful to be logical about it.”

More Americans are eligible to open an HSA — a kind of tax-free savings account that lets them sock away money for medical expenses — after changes that were part of new legislation last year. But an HSA can be a headache to set up and navigate.

Here’s what to know about how they work and when they’re worth it.

Like a Tax-Free Investment Account for Medical Expenses

With an HSA, you set aside money from your paycheck before taxes, and you can use that money to pay for medical expenses later. , including medications, glasses, orthodontia, and many kinds of therapy.

You have options for the money in the account, including investing it. Some people call HSAs a “triple tax advantage”: There are no taxes on the money that goes in, no taxes on any interest earned, and no taxes on the money that comes out for medical expenses.

Pro tip: An HSA is not the same as an FSA, or flexible spending account, even though it sounds similar. An FSA also lets you put pretax income into an account for medical expenses, but you typically lose unspent money at the end of the calendar year. By contrast, HSA money stays in your account until you spend it. Think F for “forfeit” and H for “hold on to.”

The Admin Work of an HSA Can Be a Real Barrier

First, you have to find out whether your health plan allows for an HSA. Most high-deductible health plans do, but with these plans you might have to spend thousands of dollars before most benefits kick in. Starting this year, plans on the individual Affordable Care Act marketplace that are categorized as “bronze” or “catastrophic” are also eligible. (The easiest way to find out whether you qualify is to call the number on the back of your insurance card and ask.)

Then, you have to open the HSA on your own through a financial institution — although if you get health insurance through a job, your employer might have preferred institutions. And finally, you have to keep track of your qualified medical expenses. You pay for them using a special debit card or by submitting claims for reimbursement, usually through an online portal. Either way, it’s smart to hold on to receipts.

People and Policy

If you’re living paycheck to paycheck, you may find it difficult to take advantage of the tax savings that come with an HSA. “HSAs, in this way, tend to benefit more the higher-income enrollees, because those are the ones who have the disposable income to set aside at the end of the month,” said Michelle Long, a policy researcher at KFF, a health information nonprofit that includes ºÚÁϳԹÏÍø News. Plus, people with higher incomes and higher tax brackets have more to gain from getting discounts on their taxes, which is basically what an HSA provides.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ºÚÁϳԹÏÍø News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

When she noticed an unusual craving for hot dogs, Matte’a Brooks suspected her body was telling her something, so she decided to take a pregnancy test. She took two just to be sure. Both were positive.

“I was definitely scared,” said Brooks, 23, who was uninsured. “I was like, OK … I’m pregnant, so where do I go from here?”

Until then she hadn’t thought much about health care, but that changed when she found out that her daughter was on the way.

Brooks got that news last winter. The mix of joy, anxiety, and excitement she felt mirrors what many new parents feel at this time of year. Many Americans find out in January or February that they’re expecting, because in the U.S., August has consistently high birth rates.

A growing body of research shows that prenatal care can make a huge difference to the long-term health of both the parent and baby. This is part of why offers health coverage to pregnant women who meet income requirements and might otherwise go uninsured.

As a result, Medicaid pays for more than 40% of births in the U.S. and an even higher percentage in rural areas, according to KFF. But Medicaid also comes with limitations, and providers may restrict how many Medicaid patients they take, since the payments are than other insurers’.

Here are three things to know about signing up for Medicaid when pregnant.

1. Pregnancy Makes You a Priority

To sign up for government health care, you have to meet a number of requirements that vary widely by state. Most importantly, your income has to be below a certain threshold. In several states, most adults cannot qualify, regardless of income, if they’re not disabled or the parent of a child.

But the math is different for pregnancy. In Tennessee, for example, the eligibility cutoff in pregnancy is the income threshold for some other residents. So if you didn’t qualify for Medicaid previously and are now pregnant, it’s worth double-checking your state’s requirements.

2. Getting Covered Can Be Surprisingly Easy

To apply, you’ll likely proof of income, your Social Security number, and proof of residency. Brooks, an Illinois resident, told HealthQ that she found the sign-up process surprisingly easy. She learned about Medicaid from the provider at her initial prenatal visit.

“They asked if I had insurance. I didn’t know anything at the time,” she said. The nonprofit clinic gave her some phone numbers for the state Medicaid agency. She called and went to an in-person appointment to complete her application. She walked out of the office with coverage. In , pregnancy results in “presumptive eligibility,” which provides immediate coverage — even without confirmation of the pregnancy — while the application goes through the approval process.

3. Coverage Can Go Beyond Standard Medical Care

Medicaid provides all prenatal care at no out-of-pocket cost and usually a of postpartum care. That’s what happened to Brooks: Her appointments, medications, and delivery were free.

States cover dental, vision, and mental health care to varying degrees. Ashley Farrell, who lost her job when she was pregnant and applied to Medicaid in Georgia, said she received “rewards for going to your appointments,” including . Benefits vary by state.

People and Policy

Some maternal health advocates about how Medicaid cuts in the One Big Beautiful Bill Act will affect pregnancy coverage. Though it’s unclear when or how, states might scale back eligibility or offerings for expectant mothers.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer — approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ºÚÁϳԹÏÍø News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

“Definitivamente me asusté”, dijo Brooks, de 23 años, quien no tenía seguro de salud. “Pensé: OK… estoy embarazada, ¿y ahora qué hago?”.

Hasta ese momento no había pensado mucho en el tema de la atención médica, pero eso cambió cuando supo que su hija estaba en camino.

Brooks recibió la noticia el invierno pasado. La mezcla de alegría, ansiedad y emoción que sintió refleja lo que muchas personas experimentan al enterarse de que serán madres o padres, especialmente en esta época del año. En el país, es frecuente que los embarazos se descubran en enero o febrero, ya que agosto es uno de los meses con mayor cantidad de nacimientos.

Cada vez hay más investigaciones que muestran que el cuidado prenatal puede tener un impacto muy importante en la salud tanto de la embarazada como del bebé, con efectos a largo plazo.

Por eso, ofrecen cobertura médica a las mujeres embarazadas que cumplen con ciertos requisitos de ingresos y que, de otro modo, podrían quedarse sin seguro.

Como resultado, Medicaid cubre más del 40% de los partos y un porcentaje aún mayor en zonas rurales, según KFF. Sin embargo, el programa también tiene limitaciones: algunos proveedores limitan la cantidad de pacientes que atienden a través de Medicaid porque sus  pagos son que los de otros seguros médicos.

A continuación, tres cosas que debes saber sobre cómo inscribirte en Medicaid si estás embarazada:

1. El embarazo te da prioridad

Para afiliarse al seguro médico del gobierno hay que cumplir con una serie de requisitos, que varían mucho según el estado. El más importante es el nivel de ingresos, que debe estar por debajo de cierto límite. En varios estados, la mayoría de las personas adultas no pueden calificar, sin que importe el dinero que ganan, a menos que tengan una discapacidad o sean madres o padres de un menor.

Pero el cálculo cambia si estás embarazada. En Tennessee, por ejemplo, el umbral de ingresos para ser elegible para Medicaid durante el embarazo es de alto que el que rige para otros grupos. Así que, si antes no calificabas y ahora estás embarazada, vale la pena que revises nuevamente los requisitos de tu estado.

2. Obtener cobertura puede ser más fácil de lo que parece

Para solicitar Medicaid, probablemente de tus ingresos, tu número de Seguro Social y tu lugar de residencia.

Brooks, quien vive en Illinois, contó a HealthQ que el proceso para inscribirse fue más fácil de lo que esperaba. Se enteró sobre Medicaid durante su primera consulta prenatal.

“Me preguntaron si tenía seguro médico. En ese momento yo no sabía nada”, dijo. En la clínica comunitaria sin fines de lucro donde se atendió le dieron los números de teléfono de la agencia estatal de Medicaid. Llamó, fue a una cita en persona y completó su solicitud. Salió de la oficina con cobertura médica.

En , el embarazo da lugar a lo que se llama “elegibilidad presunta”, lo que significa que se otorga cobertura médica inmediata —incluso sin confirmación del embarazo— mientras se procesa la solicitud oficial.

3. La cobertura va más allá de la atención médica básica

Medicaid cubre todo el cuidado prenatal sin ningún costo para la paciente y, en general, también incluye de atención posparto. Así fue en el caso de Brooks: las consultas, los medicamentos y el parto fueron gratuitos.

Los estados también cubren, en distinta medida, atención dental, de la vista y de salud mental. Ashley Farrell, quien perdió su empleo cuando estaba embarazada y solicitó Medicaid en Georgia, dijo que recibió “recompensas por asistir a las consultas médicas”, como .

Los beneficios varían en cada estado.

Personas y políticas públicas

Algunos defensores de la salud materna por cómo los recortes a Medicaid promovidos por la ley conocida como One Big Beautiful Bill Act podrían afectar la cobertura para las embarazadas.

Aunque aún no está claro cuándo o cómo ocurrirán los cambios, es posible que los estados pongan más requisitos para acceder al programa o limiten los beneficios para quienes esperan un bebé.

Katherine Ruppelt, de Nashville Public Radio, colaboró con este artículo.

HealthQ es una serie sobre salud de los reporteros Cara Anthony y Blake Farmer. Son guías accesibles dentro de un sistema de salud que no lo es tanto. Es una colaboración entre Nashville Public Radio y ºÚÁϳԹÏÍø News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).