03/16/2026
Big news if you or a family member are on Medicare.
Starting July 1, 2026, Medicare will begin covering Zepbound and Wegovy, and many people will be able to get them for about $50 a month.
For people over 65 living with obesity, this is a very big deal.
For years these medications have often cost $1,000 or more per month, which meant most Medicare patients simply could not access them.
What many people do not realize is that Medicare has actually been legally prohibited from covering medications used solely for weight loss. Not just slow to adopt them. Not reluctant. Prohibited by law. Congress has tried for years to change that, but the law has never passed.
So how is Medicare suddenly covering them?
The agency that runs Medicare has something called the Innovation Center. It allows them to run pilot programs and test new payment models without Congress rewriting the law first. That is exactly what they are doing here.
Think of it as Medicare running a real-world test to see how covering these medications works.
Like most Medicare medications, it will still require a prescription and prior authorization from your doctor.
Here is how the program works.
Phase 1: July 1 through December 31, 2026
During the first six months, Medicare will run the program directly rather than through your usual drug plan.
For patients, that makes it very simple:
- No deductible
- No complicated cost sharing
- About $50 per month
Medicare negotiated prices directly with the drug companies and is absorbing the financial risk during this pilot phase.
Phase 2: Starting January 1, 2027
After the pilot period, these medications move into regular Medicare Part D drug plans.
Before you meet your deductible, your monthly cost will be capped at about $245. Once your deductible is met, it drops to around $50 per month.
There will also be an annual out-of-pocket cap, which means there is a ceiling on how much you can spend in a year.
So it becomes a little more complicated than the pilot phase, but still dramatically better than what people are paying right now.
Who qualifies?
In general, Medicare is focusing on patients with moderate to severe obesity or obesity with related health conditions.
You qualify if you have:
- BMI 35 or higher
- BMI 30 or higher with conditions like heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher
- BMI 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease
Your doctor will still need to submit a prior authorization, and the medication must be prescribed alongside lifestyle treatment.
One important thing to know
Participation by Part D plans is voluntary, which means coverage will depend on whether your specific plan decides to participate.
Most plans are expected to honor the $50 cap, but some basic plans may charge more.
Because of that, it would be wise to check whether your plan intends to participate. If it does not, this is something you may want to consider during Medicare open enrollment in the fall, when you have the opportunity to switch to a plan that does cover these medications.
If you or a family member are on Medicare, here are three smart steps:
- Ask your doctor whether you might qualify
- Call your Part D plan and ask specifically about GLP-1 coverage under the Medicare Bridge Program
- Review your options during Medicare open enrollment this fall if your current plan does not participate
As a physician who treats obesity every day, I am hopeful this finally opens the door for many older patients who have simply been priced out of these medications.
It is not perfect, and it is not permanent yet.
But for millions of Medicare patients, it could finally make these medications possible.
