Medicare covers Wegovy only as a treatment to reduce the risk of heart attacks and strokes in people who are overweight or obese. It does not cover Wegovy for weight loss.
Wegovy (semaglutide) is a prescription medication that helps adults and children over 12 lose weight by controlling appetite. It’s used for obesity or overweight linked to conditions like high blood pressure, diabetes, or high cholesterol. Medicare is currently forbidden by law from covering Wegovy for weight loss or weight management.
However, in March of 2024,
This article reviews the Medicare requirements for a Wegovy prescription and discusses which parts of Medicare cover the cost of this medication if you qualify.
Is Wegovy going to be covered by Medicare for weight loss in 2026?
Although the U.S. government previously considered allowing Medicare to cover anti-obesity drugs such as GLP-1 medications for weight loss alone, it has since decided against this proposal. As of now, drugs like Wegovy will not be covered by Medicare for weight loss only.
To get Medicare coverage for Wegovy, you’ll first need to get Medicare drug coverage. You’ll then need to qualify for a Wegovy prescription from a Medicare-approved doctor.
How to get Medicare prescription drug coverage
There are two ways you can get Medicare prescription drug coverage:
- You can sign up for Medicare’s prescription drug coverage (Part D). Medicare Part D helps pay for medications that are not covered under Medicare Part A (hospital coverage) or Medicare Part B (medical coverage).
- You can sign up for a Medicare Advantage (Part C) plan. Medicare Advantage plans are sold by private insurance companies. They cover all the same services as Original Medicare (parts A and B), and most provide prescription drug, dental, vision, and hearing coverage.
You can visit Medicare.gov/plan-compare to get information on Medicare Part D drug coverage and Medicare Advantage plan costs.
If you see a plan you’re interested in, you can call the number provided to get more detailed information about drug coverage and cost.
What diagnosis will cover Wegovy for Medicare?
Medicare Part D provides coverage for Wegovy if a Medicare-approved doctor determines that the medication is necessary to prevent a heart attack, stroke, or other heart-related issues in people who have received a diagnosis of cardiovascular disease and who are overweight or obese.
Medicare Part D provides coverage because Wegovy is a self-administered medication. Original Medicare (parts A and B) does not cover Wegovy because Medicare Part B covers only doctor-administered drugs.
If you have a Medicare Advantage plan, check with your health plan administrator to make sure Wegovy is covered. Medicare Advantage plans and their associated drug coverage and costs vary by plan.
Does Medicare cover Ozempic for weight loss?
Medicare may cover Ozempic (semaglutide), but only for people with diabetes who need the medication to manage their blood glucose levels.
If you have Medicare Part D or a Medicare Advantage plan, you should talk with your plan administrator to find out whether Ozempic is on the plan’s list of covered drugs and whether you qualify for Ozempic coverage.
The exact cost of Wegovy under Medicare Part D and Medicare Part C (Advantage plans) varies based on the prescription benefits your plan offers. Medicare Part D and Advantage plans have different monthly premiums, deductibles, and copayments.
Drug plans may require prior authorization for certain medications. In addition, certain drug plans may consider Wegovy to be a specialty or “higher tier” medication, which allows them to charge a higher copayment.
Visit this page on the Medicare site to learn about different Medicare Part D and Part C plans, what medications they cover, and how much they cost.
This Medicare comparison tool can also help you compare Medicare drug plans and their costs.
Terms and definitions
Here are definitions of terms that you may find useful:
- A deductible is the amount you must spend each year before Medicare begins to pay for treatment.
- A copayment is a fixed dollar amount you pay when receiving certain treatments, often including prescription medications.
- Out-of-pocket costs: These are the costs you pay for medical care when Medicare does not provide coverage or when it pays only part of the total cost. These costs can include deductibles, copayments, and monthly premiums.
Why doesn’t Medicare cover weight loss drugs?
The Medicare Modernization Act of 2003 forbids Medicare from covering weight loss medications. Due to this law, Medicare can cover Wegovy only for people who have received a diagnosis of cardiovascular disease.
Wegovy is a type of medication that doctors primarily prescribe for weight loss. Medicare does not provide coverage for Wegovy for weight loss or weight management.
However, Medicare does provide coverage for Wegovy when a Medicare-approved doctor prescribes it to help prevent life threatening cardiovascular events in adults with obesity or overweight.