Does Medicare Cover Weight Loss Drugs?

Medicare now pays for some weight loss drugs if you qualify, through December 31, 2027. Drug plans generally still can't pay for drugs used only for weight loss, so a separate program fills the gap. Medicare also pays for counseling, classes and, for some people, surgery. If a pharmacy quoted you hundreds of dollars a month for these drugs, this may change your math.

You may qualify for the $50 price if

• You have a Medicare drug plan (Part D), on its own or in most Medicare Advantage plans.
• Your BMI and health problems meet Medicare's rule, shown below.
• You don't have type 2 diabetes, moderate to severe sleep apnea or a type of fatty liver disease. With those, your drug plan may pay instead.

Not sure Medicare will pay? Ask anyway, because your doctor's office can send the request. Or a Pair Team advocate can check with you.

What Medicare pays for (2026)

Who qualifies for weight loss drugs through Medicare?

You qualify for the $50 program if you're 18 or older with a drug plan and meet one rule below. The Centers for Medicare & Medicaid Services (CMS) sets the rules:

• A BMI of 35 or more.
• A BMI of 30 or more, plus kidney disease at stage 3a or higher, or blood pressure above 140/90 on two medicines. A stiff heart muscle (heart failure with preserved ejection fraction) also counts.
• A BMI of 27 or more, plus prediabetes or a past heart attack or stroke. Blocked leg or arm arteries that cause symptoms also count.

Your doctor must confirm you're on a diet and exercise plan. Medicare mails a letter when you're approved. Approval lasts through December 31, 2027, unless you change drugs.

What if I also have diabetes, sleep apnea or heart disease?

With type 2 diabetes or moderate to severe sleep apnea, your drug plan may pay instead, CMS says. Then the $50 program isn't for you. Your copay counts toward the $2,100 cap ($2,400 in 2027). See diabetes and Medicare.

If you've had a heart attack or stroke, a BMI of 27 is enough for the $50 program. With high blood pressure, you need a BMI of 30 and a reading that stays high on two medicines. See heart disease and Medicare and high blood pressure and Medicare. If pain makes it hard to exercise, see chronic pain and Medicare.

What will Wegovy or Zepbound cost me?

Wegovy, Zepbound KwikPen or Foundayo costs $50 a month through the program, Medicare.gov says. It runs outside your drug plan, so the $50 doesn't count toward your deductible or yearly cap. Extra Help and coupons can't lower it.

On January 1, 2027, Ozempic, Rybelsus and Wegovy get a price Medicare negotiated. It's $274 for a month's supply, down from a $959 list price in 2024, CMS says. It applies when your drug plan covers the drug, like Ozempic for diabetes, so your share may drop.

Does Medicare pay for weight loss surgery?

Yes, Medicare pays for some weight loss surgery, like gastric bypass, if you meet three rules, CMS says. Your BMI must be 35 or more, and you need a health problem tied to weight, like type 2 diabetes. Other treatment must also have failed. Medicare doesn't pay for rides there. See rides to medical appointments.

What to do next

1. Ask your primary care doctor for your BMI and about weight counseling, which costs nothing at a BMI of 30 or more.
2. Ask if a GLP-1 drug is right for you, and whether it goes through the $50 program or your drug plan.
3. Watch for Medicare's letter. To check on a request, call 1-800-MEDICARE (1-800-633-4227).
4. Check your drug plan during Open Enrollment, each fall from October 15 to December 7. If you take a GLP-1 for diabetes, make sure it's covered next year.
5. Apply for help with other drug costs. See Extra Help and Medicare Savings Programs.

If you also have Medicaid

With Medicaid too, your drugs still come through Medicare, so the same $50 program applies. If you're a Qualified Medicare Beneficiary (QMB), no doctor may bill you for Medicare's 20%. See Medicare and Medicaid together and the rules in California and New York.

What a Pair Team advocate does

Weight often comes with high blood pressure, diabetes or joint pain, so the care has to fit together. This is what we do:

• Ask your doctor about the counseling, classes and drugs Medicare pays for, and follow up on approvals.
• Book primary care visits and lab tests, and help you track numbers like blood pressure.
• Help with Extra Help and Medicare Savings Program forms, and check your drug plan each fall.
• Set up rides, and find help with food costs.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Does Medicare pay for Ozempic for weight loss?

Medicare doesn't pay for Ozempic for weight loss, because the $50 program covers only Wegovy, Zepbound and Foundayo. If you have type 2 diabetes, your drug plan may pay for Ozempic.

Will the $50 weight loss drug program end?

The $50 weight loss drug program is set to end December 31, 2027, CMS says. A longer plan was due in 2027, but CMS put it off in 2026 with no new date. For updates, see Medicare.gov/glp1bridge.

Can I get the $50 price with Medicare Advantage?

You can get the $50 price with most Medicare Advantage plans that include drug coverage, Medicare.gov says. With Original Medicare and no drug plan, you can join one at certain times, like Open Enrollment each fall.

Does Medicare pay for a gym or a diet program?

Original Medicare doesn't pay for gym memberships or fitness programs, Medicare.gov says. Some Medicare Advantage plans add them, so ask. Your counseling visits can help you plan exercise that fits your body.

How do I find my BMI?

Your BMI is a number based on your height and weight, and your doctor's office can tell you. The Centers for Disease Control and Prevention also has an adult BMI calculator online.

What if Medicare or my plan says no?

If Medicare or your plan says no, ask your doctor's office to check the request. You can appeal a plan's no on a drug for diabetes or sleep apnea. See appeal a Medicare denial.

Sources

• Weight loss drugs, Medicare.gov
• Medicare GLP-1 Bridge, CMS
• Medicare GLP-1 Bridge: Information for Part D Plans, CMS
• BALANCE Model, CMS
• Obesity behavioral therapy, Medicare.gov
• National Coverage Determination 210.12, Intensive Behavioral Therapy for Obesity, CMS
• Bariatric surgery, Medicare.gov
• National Coverage Determination 100.1, Bariatric Surgery, CMS
• Medicare Diabetes Prevention Program, Medicare.gov
• Medical nutrition therapy services, Medicare.gov
• Support for chronic health conditions (ACCESS), Medicare.gov
• ACCESS Technical Frequently Asked Questions, CMS
• Negotiated Prices for Initial Price Applicability Year 2027, CMS
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• Gym memberships and fitness programs, Medicare.gov
• Extra Help with Medicare prescription drug costs, SSA