Does Medicare Cover Weight Loss Drugs Like Ozempic or Mounjaro?
Key Takeaways
- GLP-1 agonists like Ozempic, Mounjaro, and Wegovy have become a popular method of weight loss.
- While Medicare Part D prescription drug plans and Medicare Advantage plans don’t cover medications specifically for weight loss, they can choose to cover these drugs when prescribed for a medical reason.
- Medicare coverage can help you access other weight loss services such as screening, and behavioral counseling.
- A Medicare Advantage plan may offer additional benefits like fitness programs.
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. In addition, Wegovy, a formulation of the same drug in Ozempic, was at first marketed for weight loss, but the U.S. Food and Drug Administration has now also approved the medication for lowering the risk of heart disease.
If you’re currently enrolled in Medicare or becoming eligible soon, you should understand how you may be able to access these drugs and what other coverage is available to help you manage your weight.
What Weight Is Right for Older Adults?
The most recent data available from the Centers for Disease Control and Prevention (CDC) shows that just under 42% of U.S. adults are obese. 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.
There’s a wide variety of chronic conditions associated with obesity, like heart disease, type 2 diabetes, stroke, autoimmune diseases, and certain cancers. As a result, healthcare providers often consider weight a serious concern.
Before embarking on any weight loss plan, talk with your doctor about your overall health. 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.
Even if your BMI looks a little high, that does not necessarily mean you need to start shedding pounds. Research shows that being moderately overweight by the standards used for younger people can actually become beneficial as we age. A little excess fat might protect you from breaking a bone when you fall or provide stores of energy to help you through treatments for serious illnesses.
When discussing your health with medical professionals, it’s important that you feel supported and respected, no matter what you weigh. There’s evidence that, just like other people in U.S. society, healthcare providers often have a biased perspective on heavier people, which may become apparent through insensitive language or a lack of comfortable accommodations in the office. If you feel you have experienced biased treatment, Harvard Medical School suggests advocating for yourself by speaking directly to your provider and their staff about the issue.
Ozempic, Wegovy, Mounjaro and Medicare
People on Medicare can enroll in a variety of Part D prescription drug plans or a Medicare Advantage plan with drug coverage. 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. However, federal regulations exclude certain pharmaceuticals from coverage by any Medicare plan, including prescriptions for weight loss, weight gain, or the treatment of anorexia.
In November 2024, the Biden administration proposed a rule change that would reclassify GLP-1s as treatments for chronic disease. The new rule would require Medicare and Medicaid, the state-run health insurance program for people with limited income and resources, to cover these drugs. However, that change has not yet gone into effect.
For now, that means Medicare Part D or Medicare Advantage plans can decide to cover medications like Ozempic, Mounjaro, and Wegovy when prescribed to manage diabetes or prevent heart disease, but they will not cover drugs that are specifically for weight loss. If these prescriptions are covered by your plan, they may be classified in a specialty tier that requires you to pay coinsurance of 25 to 33% until you reach the annual cap on out-of-pocket spending, which is $2,000 as of 2025.
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). Some Medicare Advantage or Part D plans offer their own discount cards, but these can only be used for covered medications.
Since drugs like Ozempic, Wegovy, and Mounjaro are currently sold by their manufacturers at high list prices, purchasing them for weight loss without Medicare coverage could be too expensive for many people, even after applying a manufacturer’s discount.
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How Medicare Can Support Weight Loss
There is other help available to people on Medicare who want to lose weight. 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. Your provider will guide you to plan changes in your eating habits and activities, set goals, and develop the necessary skills, confidence, and support system to succeed.
Medicare covers weekly counseling visits for the first month, then biweekly visits through the sixth month. If you lose at least three kilograms (6.6 pounds) during this time, coverage for monthly visits will continue for another six months.
People on Medicare who are severely obese and who have been unsuccessful with other forms of treatment may be able to undergo bariatric surgery. To have a procedure such as gastric bypass surgery or laparoscopic banding surgery covered, your BMI must be over 35 and you need to be diagnosed with at least one comorbidity (another medical condition associated with obesity).
Medicare Advantage plans may provide supplemental benefits that could be a big help in managing your weight. Many plans include access to gyms as well as to fitness programs you can participate in from home. Some people qualify for assistance with buying groceries and over-the-counter items that could help you get better nutrition.
Everyone’s body is different, and you should set the diet and exercise goals that make sense for you. 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.