Your costs will depend on whether you have insurance coverage or pay cash. Call your insurer or check your plan documents to confirm whether your GLP‑1 medication is covered for your specific diagnosis. As of January 2026, only 13 state Medicaid fees‑for‑service programs cover GLP‑1s for obesity treatment down from 16 in late 2025. Ozempic, Trulicity, and More: 11 GLP-1 Drugs and How to Navigate Your Options Millions of people have begun using drugs like Mounjaro and Ozempic — a class of medications called GLP-1 agonists that’s mainly intended to control diabetes — to lose weight. Understanding Medicare coverage for weight loss drugs can feel overwhelming, but knowing the key details can help you make informed choices. These plans can include benefits for gym memberships, fitness programs, and some weight loss medications. With commercial insurance, you may be able to pay as little as $25 for a 1-month supply with a Wegovy savings offer. Wegovy was FDA approved in March 2024 to reduce the risk of a life-threatening cardiovascular event in adults who are considered obese or overweight and have a cardiovascular condition. However, if Wegovy is prescribed to reduce the risk of a heart attack, stroke, or other severe cardiovascular condition, Medicare will allow coverage for Part D enrollees. Wegovy was first approved in 2021 for chronic weight management. The manufacturer of Ozempic, Novo Nordisk, offers a cost navigator tool to help you determine if your insurance covers the medication. At that time, it became the first weight-loss medication to gain this indication. LeafyBark isn’t just a source of information; it’s a community where health-conscious individuals connect and thrive. For example, nutrition counseling or fitness classes may be eligible for reimbursement, as they are considered health-related expenses. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. About the authorsTony Pugh is an award-winning writer and editor covering Medicare for AARP. This story, originally published Sept. 13, 2023, was updated to reflect the FDA’s recent approval of a pill form of Wegovy and CMS’s two-step plan to lower prices for Medicare Part D enrollees. You can’t contribute to a health savings account after you enroll in Medicare, but if you’ve already accumulated money in an account, you can withdraw it tax-free at any time for eligible expenses. This represents a substantial reduction from typical retail prices that can exceed $1,200 monthly. Documentation of treatment failure or contraindications to preferred medications supports approval requests. Coverage requires proper documentation of sleep study results and obesity-related sleep apnea diagnosis. When Medicare doesn’t provide coverage for weight loss medications, several strategies can help manage the substantial costs. Significant changes to Medicare Part D in 2025 improve affordability for beneficiaries requiring expensive medications, including qualifying weight loss drugs. This indication allows Medicare Part D plans to cover Wegovy when prescribed specifically for cardiovascular protection rather than weight loss. Medicare Part D plans typically cover these drugs on their formularies, though prior authorization requirements and step therapy protocols may apply depending on the specific plan. This unique program combines personalized coaching, nutrition, and exercise plans to help individuals achieve sustainable weight loss. KFF’s 2025 employer survey findings reflect that larger employers are more likely to cover these medications, but many say coverage has a significant impact on prescription drug spending. Medicare Part D historically excludes “agents when used for anorexia, weight loss, or weight gain,” which is why broad coverage for obesity treatment is limited. If it becomes official coverage policy, this change would also lift the burden off lawmakers in Congress who have repeatedly introduced legislation to authorize Medicare coverage of anti-obesity drugs but who may have been stymied by the potential cost of doing so. But even with these coverage limits in place, gross spending on these drugs for approved uses in Medicare and Medicaid has skyrocketed in recent years, totaling $4 billion in Medicaid in 2023 and close to $6 billion in Medicare in 2022 for selected GLP-1s. Medi-Weightloss has locations across the country, making it a convenient option for those seeking a structured weight loss program. Medi-Weightloss is a comprehensive weight loss program designed to help individuals achieve their weight loss goals. Remember, weight loss is a journey, and with the right approach, you can achieve your goals and enjoy a happier, healthier life. Coverage varies by plan. Employer-sponsored insurance As mentioned, Wegovy was FDA approved in March 2024 to reduce the risk of life-threatening cardiovascular events in certain adults. For future fills and other Wegovy doses, you can pay $349 per month for the injection or $299 per month for the pill. Medicaid rules are state-specific, so your best next step is to read your plan’s criteria and bring it to your clinician. We support cross-border prescription access using a cash-pay model for patients who qualify. Coverage rules for those products are not comparable to FDA-approved therapies. Can Zepbound Cause Insomnia? However, plans will not cover drugs that are specifically for weight loss. That rule would have required Medicare and Medicaid, the state-run health insurance program for people with low incomes, to cover these drugs. Each of these plans from private insurance carriers is different, with its own formulary (a list of covered medications), and costs for coinsurance, monthly premiums, and annual deductibles. The federal government’s stance on Medicare prescription drug coverage is very important for deciding which weight loss medications are included. It helps to separate “coverage” from “clinical fit.” A drug can be appropriate medically yet still hard to cover. If the drug is coverable but restricted, you can plan for the paperwork. Others may cover a GLP-1 medicine for diabetes but not for weight management. Some states cover certain anti-obesity medications, often with prior authorization. Many older adults are covered through Medicare Advantage (Part C) or an employer-sponsored retiree plan that wraps around Medicare. These clinical questions provide ACG members with a good opportunity to educate and collaborate with policymakers tasked with reviewing potential coverage of GLP-1 medications in the future. In October 2024, the Congressional Budget Office (CBO) analyzed the impact of the proposed change to cover anti-obesity medications. In addition, the United States Preventive Services Task Force (USPSTF) is developing a draft recommendation statement on whether weight-loss interventions affect health outcomes such as cardiovascular disease. Schedule your FREE call today to get expert guidance, compare plans, and make confident decisions about your healthcare—all at no cost to you! We work with over 30 top insurance companies to ensure you get access to the best plans available. What Weight Is Right for Older Adults? Pharmaceutical assistance programs are usually limited to FDA-approved use. And it has a savings card for people without insurance. Novo Nordisk offers access to a health coach for diet and exercise to help people taking Wegovy. Retiree health insurance. Your next step should be to verify your specific plan's coverage. Insurance coverage for GLP‑1 medications is changing significantly in 2026. And, Fitch notes, Medicare sets the standard for coverage in insurance generally, so this move could ultimately affect more patients. If you have commercial insurance, you could pay as little as $25 per 1-month supply of Wegovy injections or pills, with maximum savings of $100 per 1-month prescription. What you actually pay can vary depending on several factors, such as your insurance coverage, location, and pharmacy. Rybelsus is an oral version of semaglutide that’s also approved for blood sugar control in people with Type 2 diabetes. So, “does Medicaid cover weight loss shots” depends on your state’s formulary, your eligibility group, and the plan managing your benefits. A plan may require that the prescription aligns with a covered indication and that your clinician’s documentation supports it. Historically, drugs “for weight loss” have been in that excluded category. If you don’t use tax-free money from an HSA, weight loss medication prescribed for a medical condition, such as diabetes or obesity, can be a tax-deductible medical expense, says Barbara Weltman, author of J.K. Drug manufacturers often have programs to help with drug costs and copayments for people without insurance. The two gatekeepers: plan exclusions and prior authorization Starting in April 2026, Medicare will cover GLP‑1 medications for beneficiaries who have obesity and qualifying comorbidities, such as type 2 diabetes or heart disease. For decades, Medicare was prohibited from covering drugs prescribed solely for weight loss. At the same time, many state Medicaid programs and commercial insurers are dropping or restricting coverage for weight loss. However, if you are covered by a government-funded insurance program, such as Medicaid, Medicare, or Tricare, you do not qualify for this Wegovy savings offer. Additionally, the program has been shown to improve overall health, reducing the risk of chronic diseases like diabetes and heart disease. However, it’s unlikely that Medi-Weightloss would be covered under these plans. Medicare covers IBT, a comprehensive weight loss program that includes counseling, nutrition education, and physical activity. How Coverage Varies by Plan and Region Medicare generally does not cover medications prescribed solely for weight loss. If you are looking to lose weight and thinking about using medication, it’s important to know how Medicare helps with weight loss drugs. However, if the medications are approved for another purpose, such as Type 2 diabetes, then Medicare may cover them. Current law doesn’t allow Medicare to cover medications such as Ozempic, Wegovy, Mounjaro, and Zepbound, for weight loss. High-cost specialty medications often fall on higher formulary tiers with coinsurance rates between 25% and 33%, depending on the plan’s deductible structure. The Inflation Reduction Act established a $2,000 annual out-of-pocket maximum for Medicare Part D prescription drugs in 2025. This medical indication enables potential Medicare coverage when the medication is prescribed to address sleep apnea rather than weight management. Medicare Advantage plans, also called Part C, may offer extra benefits not found in Original Medicare (Part A and Part B).Many plans include access to gyms as well as to fitness programs you can participate in from home.Weight is just one of many factors that can affect your well-being as you age, so engage with your healthcare provider and seek out support as you pursue a healthy lifestyle in the years ahead.Another Novo Nordisk medication, Ozempic, which is approved to help people with Type 2 diabetes manage their blood glucose (sugar) levels, also contains semaglutide — but at a lower dose than Wegovy.Programs targeting continuing education can help offset the costs of training, allowing for better career opportunities that might offer health benefits inclusive of weight management support.Medicare plans are prohibited by law from covering prescription medications taken solely for weight loss.After that, you can pay $299 or $349 per month, depending on the medication and dose.The key is keeping your prescriber in the loop, so the prescription matches the dispensing pharmacy’s requirements. If you lose at least three kilograms (6.6 pounds) during this time, coverage for monthly visits will continue for another six months. If you’re considered obese, Medicare Part B and Medicare Advantage plans cover screening and behavioral counseling from your primary care provider at no cost. The CDC defines obesity as a body mass index (BMI) — calculated by dividing a patient’s weight by their height — of over 30, significantly higher than the range of 18.5 to under 25 that medical professionals consider healthy. In addition, the FDA cleared the weight loss drug Zepbound to treat patients with moderate-to-severe forms of obstructive sleep apnea. Wegovy, a formulation of the same drug in Ozempic, was at first marketed for weight loss, but the U.S. For people who split time between states, plan service areas can also matter. They may limit coverage to certain pharmacies, require specific documentation, or prefer one product over another. This overlap is a major reason coverage conversations are confusing. Drugmakers such as Novo Nordisk, which also makes the diabetes drug Ozempic, and Eli Lilly are studying their weight loss medicines as treatments for fatty liver disease, chronic kidney disease, sleep apnea and more. Under the new CMS guidance, Medicare Part D plans can cover obesity treatments that receive Food and Drug Administration approval for an additional health benefit. While these drugs are relatively new, there are several FDA-approved weight loss drugs on the market. Medicare is also prohibited by law from covering prescription medications taken solely for weight loss. ACA marketplace plans aren’t required to offer obesity medication coverage, but some plans may. This restriction applies even if your insurance plan includes prescription medication coverage. Wegovy (semaglutide) gained FDA approval for reducing cardiovascular death, heart attack, and stroke risk in adults with established cardiovascular disease who are overweight or obese. Excess weight can cause secondary health issues to occur, but it can be difficult to lose weight with exercise and diet alone. FDA approves treatment for serious liver disease known as ‘MASH’. Does Tricare cover Wegovy, Ozempic, and Mounjaro? For future fills and for other Wegovy doses, you can pay $349 per month for the injection or $299 per month for the pill. While exploring alternatives, always consider speaking to a financial adviser or healthcare professional who can offer personalized advice suited to individual circumstances. Whether switching careers for health benefits or simply seeking knowledge, educational grants might open paths to improve financial stability. Individuals could explore these possibilities, often with assistance from healthcare providers who can guide them through Medicare’s intricate requirements. The new guidance also applies to state Medicaid plans, which also would be required to cover Wegovy for patients with both higher weight and heart disease risk. That finding prompted CMS to change its Medicare Part D drug program to cover Wegovy, although it noted that this applies only for those patients struggling with both weight and heart disease. Wegovy is a GLP-1 agonist, a class of obesity drugs promising a sea change in weight loss. Health The Centers for Medicare & Medicaid Services is testing pilot programs that could allow Medicare Part D plans to cover GLP-1 drugs specifically for weight management. Most Medicare Part D plans require prior authorization for expensive weight loss medications, even when prescribed for covered indications. While federal regulations prohibit coverage for drugs used solely for weight loss, there are important exceptions and alternative coverage options that many people don’t know about. Many insurance companies and employers that provide healthcare coverage don’t consider weight-loss medications medically necessary. Coverage for obesity care and weight-loss medications varies widely among insurance plans. Three primary categories of weight loss medications may qualify for Medicare Part D coverage when prescribed for approved medical indications rather than weight management alone. For detailed information about Medicare coverage options for weight loss medications, guidance is available to help beneficiaries understand their specific plan benefits and requirements. Federal law specifically prohibits Medicare Part D plans from covering medications prescribed solely for weight loss purposes. Rybelsus is an oral version of semaglutide that’s also approved for blood sugar control in people with Type 2 diabetes.In other words, the injections, which can cost well over $1,000 a month out of pocket, will not be covered for enrollees only seeking to lose weight.Most Medicare Part D plans require prior authorization for expensive weight loss medications, even when prescribed for covered indications.With the change in government in 2025 and the Trump administration now in power, it is unknown if the Treat and Reduce Obesity Act will be moved forward and written into health policy.But plans will decide on prior authorization requirements showing that people meet the cardiovascular or liver disease risks.Wegovy (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that was FDA approved in 2021 for chronic weight management.You may also be able to get a prescription for Wegovy online, using a telehealth service. This surge strained state and employer budgets, leading many to restrict coverage to control costs. If you lose coverage or pay cash, new direct‑to‑consumer prices are significantly lower than former list prices. For Medicare beneficiaries who qualify, the copay for GLP‑1 medications will be capped at $50 per month. Do not assume your coverage remains the same as last year. States like California, New Hampshire, Pennsylvania, and South Carolina have recently eliminated this coverage. They may know of local patient assistance programs, clinical trials, or alternative medications that are more affordable. They provide FDA‑approved medications at reduced cash prices. The Medicare demonstration project covers GLP‑1s for obesity with qualifying comorbidities, which include obstructive sleep apnea. This could explain why many are dropping coverage just as more affordable cash options appear. You may also be able to get a prescription for Wegovy online, using a telehealth service. Even if you use a telehealth service, a valid prescription is still required before you can receive the medication. A healthcare professional must evaluate you and decide whether the medication is appropriate based on factors such as your body mass index (BMI), medical history, and weight-related health conditions. Yes, accessing Wegovy requires a prescription from a licensed healthcare professional. Currently, brand-name prescription drugs are still under patent. Weight loss drugs are most commonly prescribed to treat diabetes, but may also be prescribed to reduce the risk of heart attack and stroke or help patients with sleep apnea. Combined with healthy eating and exercise, these medications can help you lose weight, even after 60, when losing weight is more challenging. Many plans include access to gyms as well as to fitness programs you can participate in from home. Medicare Advantage plans may provide supplemental benefits that could be a big help in managing your weight. However, these medications can be expensive, which is a problem for those who depend on Medicare. Weight loss medications are getting a lot of attention lately. By providing your email, you consent to receive marketing communications from GoodRx, which may include content and/or data related to men's health, women's health, reproductive care, or sexual health. Novo's Wegovy picks up 3rd indication with key FDA approval in the liver disease MASH. After that, most ongoing fills are $299 or $349 per month, depending on the medication and dose. Coverage can also look different depending on where the drug is given. We connect U.S. patients with licensed Canadian partner pharmacies for prescription dispensing. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. The discounts also would apply to purchases made via a new direct-to-consumer portal, TrumpRx, scheduled to launch in early 2026 to link users to manufacturers’ websites to buy the prescriptions. On Nov. 6, the White House announced that leading GLP-1 manufacturers Eli Lilly and Novo Nordisk will lower prices for the popular medications when they’re purchased through Medicare. “Today’s announcement builds upon our … goal of democratizing access to weight-loss medication, which has been out of reach for so many in need,” says Dr. Mehmet Oz, CMS administrator. This reinterpretation reflects an evolution in the understanding of obesity as a disease and weight loss as conferring real health benefits in people with obesity rather than being merely for cosmetic purposes. Around 1 in 5 state Medicaid programs currently cover GLP-1 drugs for weight loss. The guidance also will open the door to future coverage of other weight loss medications, many of which are being tested for additional health conditions. Medicare Part D will cover Ozempic when it’s used to manage diabetes. Alli, an over-the-counter version of Orlistat, has been an effective weight loss aid for dieters, but Xenical contains more Orlinstat for greater effectiveness. Original Medicare (Part A & Part B) generally doesn’t cover prescriptions. These drugs are generally not covered if prescribed simply for weight loss. Sometimes known as anti-obesity drugs, weight loss medications can help you manage your weight in different ways. Drug manufacturers may offer discount cards or coupons to lower the costs of medications that are not covered by insurance (these discounts cannot be used for covered drugs). However, federal regulations exclude certain pharmaceuticals from coverage by any Medicare plan, including prescriptions for weight loss, weight gain, or the treatment of anorexia. People on Medicare can enroll in a variety of Part D prescription drug plans or a Medicare Advantage plan with drug coverage. However, weight loss medications prescribed explicitly for obesity without underlying health implications might not be covered under standard plans. A provision of a 2003 law established that Medicare Part D plans can't cover drugs used for weight loss, but the program does cover obesity screening, behavioral counseling and bariatric surgery. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. KFF analysis has found most large employer firms currently do not cover GLP-1 drugs for weight loss and coverage in ACA Marketplace plans remains limited, but if finalized, the proposed change to Medicare and Medicaid coverage could put pressure on other payers to expand access. If you have Medicaid or a commercial plan, you may lose coverage for weight‑loss use, though drugs prescribed for type 2 diabetes generally remain covered. To get coverage, you have to meet certain criteria, such as participating in a course like the MOVE!This means that Medicare beneficiaries cannot use their Medicare benefits to cover the costs of the Medi-Weightloss program.Its approval for sleep apnea and obesity allowed Medicare Part D plans to cover it for those reasons.If you lose coverage or pay cash, new direct‑to‑consumer prices are significantly lower than former list prices.We’re passionate about simplifying weight loss and wellness through clear, actionable advice.Obesity increases the risk of heart disease, stroke, type 2 diabetes and other conditions.People on Medicare can enroll in a variety of Part D prescription drug plans or a Medicare Advantage plan with drug coverage. On average, individuals on the program lose 3-5 pounds per week, and many achieve weight loss of pounds or more. It’s also worth noting that some employers or organizations may offer discounts or reimbursement for weight loss programs like Medi-Weightloss. It’s worth contacting your insurance provider to see if they cover any services or programs that may be included in the Medi-Weightloss program. While coverage would be available for Medicare and Medicaid enrollees with obesity, Medicare Part D drug plans and state Medicaid programs could still apply utilization management tools such as prior authorization, which could limit access. State Medicaid programs also have to cover these drugs for indications such as diabetes or cardiovascular disease risk reduction, but only 13 states currently cover these drugs for obesity treatment as well. For example, if one of the drugs receives FDA approval to treat diabetes or prevent cardiovascular disease, Medicare part D plans may cover it for that use. For the first time, Medicare will allow coverage of one of the new blockbuster weight-loss drugs for enrollees in Part D plans. “You can get your doctor to write you a prescription for off-label use as a weight loss drug. Novo Nordisk calls it part of a pilot program to add obesity to the list of covered medical conditions and expects that most Part D beneficiaries would be covered. For diabetes management, plans often require attempting metformin or other first-line treatments before approving GLP-1 medications. This cap applies to all covered medications, meaning beneficiaries pay nothing for covered prescriptions after reaching the $2,000 threshold. However, this exclusion doesn’t apply when weight loss medications have FDA-approved indications for other medical conditions. These medications also can help with weight loss because they make you feel fuller faster. Drugs prescribed for weight gain, cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction also aren’t allowed to be covered. In drug trials sponsored by manufacturer Novo Nordisk, the Wegovy pill resulted in an average weight loss of more than 16 percent for those who took it as directed. Doctors have been prescribing GLP-1s for weight loss because studies have found that losing 5 percent to 10 percent of your weight can have positive effects on your health. The underlying price Medicare pays manufacturers will be about $245 per month—less than half the previous list price. However CMS specified they may also require prior authorizations to ensure that is being used only for the approved use. Obesity doctor Angela Fitch says that the move to cover it even for a limited subset of patients is still significant. In clinical trials, Wegovy was found to reduce risks of cardiovascular events by 20% in higher weight patients. Before embarking on any weight loss plan, talk with your doctor about your overall health. The federal government needs to look closely at what expanding Medicare coverage for these drugs could mean for finances. Supporters for more coverage believe that this way of categorizing these drugs is outdated. The choices made by the federal government about covering weight loss medications have a big effect on Medicare’s policies. However, some medications prescribed for weight loss hold FDA approval for treating other chronic diseases. My Employer’s Plan Is Dropping GLP‑1 Coverage. Can I Ask Them to Keep It? If you have commercial insurance and qualify for the Wegovy Savings Card, you may be able to pay as little as $25 for a 1-month supply. Without coverage, Wegovy can cost around $16,000 or more annually. Wegovy was also approved in March 2024 to help prevent heart attacks, strokes, and heart-related deaths in adults with a cardiovascular condition who are considered either overweight or obese. Wegovy (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that was FDA approved in 2021 for chronic weight management. In practice, this means a plan may deny a claim when the only documented purpose is weight reduction. Common examples include prior authorization (a plan approval step) and step therapy (trying another drug first). By contrast, some injected drugs given in a clinic may fall under Part B rules. However, Medicare law has categories of medications that Part D generally does not cover when used for certain purposes. But if you are taking Mounjaro for weight loss, Medicare will not cover it. If you have private or commercial insurance, you can pay as little as $25 per prescription (up to a 3-month supply) with an Ozempic savings card. If your healthcare professional prescribes Ozempic to manage Type 2 diabetes, then Medicare may cover it as a Part D medication. Download the GoodRx app If you’re interested in the program, you may want to check with your employer or organization to see if they offer any discounts or reimbursement. On average, the cost of the program can range from $1,000 to $3,000 or more, depending on the package and services chosen. The program also offers ongoing support and maintenance, which helps individuals continue to make progress and overcome any challenges they may face. Additionally, the program is designed and supervised by medical professionals, which ensures that individuals receive safe and effective guidance. Ozempic, which the FDA first approved for diabetes and then for kidney disease, is popular for weight loss, but Medicare has been covering it only when it’s prescribed for diabetes or kidney disease. In March 2024, the FDA approved Wegovy’s use for adults with cardiovascular disease who are also overweight, which opened the door for Medicare Part D plans to cover it. But unless you’re overweight and have another ailment, such as diabetes, Medicare won’t cover any of the popular weight loss drugs like Ozempic and Wegovy until at least July 2026. Before reaching the cap, beneficiaries typically pay 25% coinsurance for covered drugs after meeting their plan’s deductible. In this article, we will delve into the intricacies of Medi-Weightloss and explore whether this innovative program is compatible with Medicare. They are decisions driven by plan exclusions, prior authorization rules, and missing paperwork. Healthcare.gov’s external review guidance notes that external review requests are generally required within a set time window after the final denial notice (commonly within four months in that framework). If renewals require a minimum weight reduction, document baseline weight carefully and schedule a follow-up around the renewal decision window. In 2017, the FDA approved Ozempic for the treatment of Type 2 diabetes.For Medicare beneficiaries who qualify, the copay for GLP‑1 medications will be capped at $50 per month.Manufacturer patient assistance programs provide additional cost relief for qualifying individuals.Each of these plans from private insurance carriers is different, with its own formulary (a list of covered medications), and costs for coinsurance, monthly premiums, and annual deductibles.Below are a few popular medications that are used for weight loss and more information about cost and coverage.Insurance coverage information for the oral Wegovy pill is not available yet.If you are comparing options because does medicare cover weight loss drugs feels like a moving target, focus on what you can verify today.On April 4, the Trump Administration announced that Medicare and Medicaid will not cover anti-obesity drugs, including the GLP-1 class of medications. If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it. Medicare now covers GLP-1s for diabetes and other approved ailments, such as obesity in conjunction with heart disease. The lower usage is likely because Medicare doesn’t cover prescriptions specifically for weight loss, the nonpartisan health policy nonprofit says. Some policies require at least a specific percentage reduction from baseline weight to continue coverage. A major shift occurred when semaglutide injection (Wegovy) gained an additional indication to reduce risk of serious cardiovascular events in certain adults with established cardiovascular disease and obesity or overweight. Nonetheless, the combination of high demand, new uses, and high prices for these treatments is likely to place tremendous pressure on Medicare spending, Part D plan costs, and premiums for Part D coverage over time. Navigating Government Aid Programs Medicare, the federal health insurance program for Americans 65 and older, as well as certain younger people with disabilities, provides coverage for various medical services. Even with perfect documentation, some plans will not cover weight loss medications. These limitations on coverage in Medicare and Medicaid mean that millions of people who have obesity and might benefit from these drugs may be unable to access them due to their high prices. The American Medical Association’s 2013 declaration of obesity as a disease provides medical foundation for these policy changes. These programs typically require income verification and may offer free or reduced-price medications for eligible patients. The service requires no copayment, coinsurance, or deductible when provided by Medicare-approved practitioners. Medicare Part B covers Intensive Behavioral Therapy (IBT) for obesity screening and counseling when beneficiaries have a BMI of 30 or higher. For expensive GLP-1 medications that may cost $1,000 or more monthly, this cap provides substantial financial protection. Medicare’s complex rules around weight loss medications leave millions of beneficiaries confused about what’s actually covered. Medicare coverage of anti-obesity medications. Wegovy’s manufacturer offers a savings program for people who have commercial insurance that covers the medication. $350 without insurance. Administration officials expect that percentage to rise to 10 percent, about 7 million people, with the GLP-1 discounts. The federal government will pay $245, a price that also will be available to state Medicaid programs. “Coverage and pricing changes will phase in during 2026 with cash prices for TrumpRx purchases as early as January,” says Michael Baker, director of health care policy at the American Action Forum. If you're new to using GoodRx for Ozempic savings, pay an introductory price of $199 per month for the first two fills (only available for certain doses). During that time, the safety and effectiveness of obesity treatments was questioned. The reasoning behind Medicare’s weight-loss medication ban can be traced back to the 1990s. Always consult with a qualified healthcare provider about any health and medical concerns. The absence of a warning on any drug does not indicate the drug is safe, effective, or appropriate. Medicare plans are prohibited by law from covering prescription medications taken solely for weight loss. The potential cost to Medicare is lower than some other estimates because it assumes many people with obesity can already get Medicare coverage of these drugs for other medically accepted indications, and CMS’s proposal would not apply to people who are overweight. Rising prescription drug costs are an ongoing concern for states, and state Medicaid programs reported the high cost of obesity drugs as key reason for not expanding coverage prior this proposal. If you are tracking when will medicare cover weight loss drugs, focus on what Medicare publishes today and watch for official updates. If you are comparing options because does medicare cover weight loss drugs feels like a moving target, focus on what you can verify today. A drug that is covered for type 2 diabetes may not be covered when the purpose is weight loss alone. But that definitely does not mean it will be covered by your plan as a weight loss medication, even if it’s covered for diabetes” or sleep apnea, Cubanski says. Medi-Weightloss is not typically covered by insurance, as it is a private weight loss program. If you have a Medicare Advantage plan, you may want to contact your insurance provider to see if they cover any weight loss services or programs. It’s important to note that while Medi-Weightloss does not accept Medicare, some Medicare Advantage plans may cover certain weight loss services or programs. Medicare is a federal health insurance program that covers certain medical expenses, but it does not typically cover weight loss programs or services. This approach helps individuals develop healthy habits and makes it more likely that they will maintain weight loss over time.Medicare Part B covers Intensive Behavioral Therapy (IBT) for obesity screening and counseling when beneficiaries have a BMI of 30 or higher.Look at your plan’s formulary to see what drugs are covered.Wegovy is a GLP-1 agonist, a class of obesity drugs promising a sea change in weight loss.News coverage and social posts can lag behind, or leave out key limitations.If you’re considered obese, Medicare Part B and Medicare Advantage plans cover screening and behavioral counseling from your primary care provider at no cost.If successful, these pilots could lead to broader Medicare coverage for weight loss medications, potentially expanding access for millions of beneficiaries. The drug maker is among those pushing for Congress to expand coverage of treatments for obesity. In a statement, Wegovy's maker Novo Nordisk said it was "encouraged" by the new guidance from CMS but said it hopes to see Part D coverage expanded for "obesity medicines when used for chronic weight management." It states that anti-obesity medications that receive FDA approval for an additional condition other than weight-management alone, can be considered a Part D drug for that specific use. "At least now we'll have coverage for those people who have a known history of heart disease," she says. Medicare Advantage plans must cover what Original Medicare covers, but the plan design can differ. Part B covers outpatient medical services, some clinic-administered drugs, and preventive care. Even when a medication is potentially coverable, plans can add utilization management tools. That is why you may hear that Medicare “doesn’t cover obesity meds,” even when the same molecule may be covered for another diagnosis. It also comes amidst high and growing demand for and use of a relatively new class of highly effective, but also very expensive, drugs being used to treat obesity, known as GLP-1s. Confirm with your Part D or Medicare Advantage plan when the coverage begins and what prior authorization criteria apply. For insurers, the high cost of covering these drugs for a large population still outweighs the clinical benefits in their short‑term budgeting. Obesity is not just a lifestyle concern; it’s a growing health crisis that necessitates effective intervention. Some of the nation's largest insurers, such as CVS Health's Aetna, also cover the treatments. Some manufacturers offer programs to reduce out-of-pocket costs for eligible patients. In addition to helping with weight loss, GLP-1s, or glucagon-like peptide-1 receptor agonists, have been found to improve heart and liver health and treat sleep apnea in overweight adults. If the federal Food and Drug Administration (FDA) approves a different GLP-1 called orforglipron that’s now being studied to treat type 2 diabetes and obesity, it also will be about $350 a month. And because the program is a test, coverage will end in December 2031 unless the program is extended. In November 2024, the Biden administration proposed a rule change that would reclassify GLP-1s as treatments for chronic disease. When discussing your health with medical professionals, it’s important that you feel supported and respected, no matter what you weigh. Speak to a licensed insurance agent (TTY 711) Currently we represent number_of_organizations organizations which offer number_of_plans products in your area. Medicare covers weekly counseling visits for the first month, then biweekly visits through the sixth month. There is other help available to people on Medicare who want to lose weight. Research shows that being moderately overweight by the standards used for younger people can actually become beneficial as we age. Medical professionals will consider your BMI along with other health factors such as your blood pressure, cholesterol levels, and blood sugar to determine if you’re at a healthy weight. We’re authorized to represent over 30 top insurance companies, ensuring you get access to the top plans in your area. This guide explains which medications are covered by Medicare, who can qualify for them, and any limits you may face. Zepbound, developed by Eli Lilly — the same pharmaceutical company that launched Mounjaro — is a new addition to the available medications for weight loss. In November 2023, the FDA approved Zepbound, an injectable prescription medication for chronic weight management in adults who are overweight. That can also affect whether a plan requests labs, diagnosis codes, or prior authorization forms. For Medicare, the key question is often the indication documented on the prescription and in your medical record. Two products can look similar on a pharmacy shelf, while having very different FDA-approved uses. IBT is offered by qualified healthcare providers, including some Medi-Weightloss doctors. The final phase focuses on maintaining a healthy lifestyle, with patients receiving ongoing support and guidance to ensure they stay on track. This phase involves gradual introduction of new foods, exercise regimens, and lifestyle changes to ensure long-term weight management. During the stabilization phase, patients learn to maintain their new weight. Before we dive into the Medicare aspect, it’s essential to comprehend the Medi-Weightloss program. Another Novo Nordisk medication, Ozempic, which is approved to help people with Type 2 diabetes manage their blood glucose (sugar) levels, also contains semaglutide — but at a lower dose than Wegovy. However, Tricare no longer covers weight-loss medications for Tricare For Life beneficiaries. Medications prescribed solely for weight-loss purposes are not covered. If your plan doesn’t offer coverage, you may be able to work with your prescriber to write a letter requesting coverage. Coverage for Wegovy and other weight-loss medications varies by plan. Keep in mind that your insurer may require prior authorization or have you try other treatments before you can get coverage. If you have Medicaid, your coverage will depend on where you live. To get coverage, you have to meet certain criteria, such as participating in a course like the MOVE! While most weight loss drugs are excluded, there are surprising loopholes and upcoming changes that could save you thousands in 2025. HHS announces 15 additional drugs selected for Medicare drug price negotiations in continued effort to lower prescription drug costs for seniors. If you have insurance, check with your provider to understand if you meet criteria for coverage and what documentation you may have to provide. With the Wegovy Savings Card, you can get the medication for as little as $25 if you have commercial insurance coverage and qualify. People covered by government-sponsored programs — such as Medicaid, Medicare, Medigap, Tricare, or VA benefits — aren’t eligible. This can reduce your medication cost to as low as $25 per prescription if you qualify. However, Medicare won’t cover the medication due to its existing policies. If you are eligible for the Mounjaro Savings Card, you can pay as little as $25 for your prescription. We’re passionate about simplifying weight loss and wellness through clear, actionable advice. The results of Medi-Weightloss are due in part to the comprehensive approach to weight loss, which addresses nutrition, exercise, and behavioral therapy. Medi-Weightloss has a proven track record of helping individuals achieve significant weight loss. It’s important to note that while the cost of Medi-Weightloss may seem high, the program is designed to provide long-term results and improve overall health. One of the main benefits is the comprehensive approach to weight loss, which addresses nutrition, exercise, and behavioral therapy. Insurance coverage for Wegovy varies widely among insurance plans. Additionally, Medicare beneficiaries have access to alternative weight loss programs and services that may be covered under Medicare. Some Medicare Advantage plans may offer additional weight loss benefits, such as access to gym memberships or wellness programs. While Medi-Weightloss itself may not accept Medicare, there are alternative weight loss programs and services that may be covered under Medicare. It is essential to find a balance between providing more coverage and being responsible with money, which often leads to tough decisions about coverage. Because of this, reclassifying these medications is important for better health results. There is strong evidence showing that medication can help treat obesity and related health issues. It’s important to understand these factors and how they affect Medicare coverage. For future fills and for other Wegovy doses, pay $349 per month for the injection and $299 per month for the pill. If you're new to using GoodRx for Wegovy savings, pay an introductory price for the first two fills of $199 per month for the injection and $149 per month for the pill (only available for certain doses). Since then, it's also been approved for cardiovascular risk reduction and to treat moderate-to-advanced liver scarring. After that, most ongoing fills are priced at $349 per month, depending on the dose.