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I’ve been trying to lose weight for a long time. I’ve tried diet and exercise, even the fad diets. Have you heard of the maple syrup and lemon diet? Nothing seems to work for me.
I recently noticed that my friend has lost a lot of weight. I asked her what her secret was, and she said Wegovy. She’s not on Medicare yet, so I’m wondering, does Medicare cover Wegovy? Could this be what helps me shed the pounds?
Eager to be a healthier weight,
Judith from Tampa, Florida
This is a great question; in fact, many people are asking the same thing.
Wegovy is a semaglutide injectable prescription medication that can help people with a Body Mass Index (BMI) higher than 30 or some adults with excess weight (BMI greater than 27). So, this may be an option for Medicare beneficiaries with obesity, not for those who want help shedding a couple of pounds.
The medication acts like your natural appetite hormones that help regulate how much food you eat. With Wegovy, your appetite hormone will be controlled and reduced, leading to eating fewer calories and losing weight. It’s recommended that Wegovy be combined with a reduced-calorie diet and increased physical activity.
I know that you’re wondering if Medicare covers Wegovy.
Original Medicare Part A and Part B do not cover Wegovy. That’s because these parts of Medicare don’t cover prescription medications. However, Medicare Part D prescription drug plans work alongside Original Medicare to provide prescription drug coverage. Unfortunately, Part D does not cover medications that help with weight loss.
Weight loss medications for cosmetic purposes, such as morbid obesity, are not included in Medicare Part D prescription drug plans, according to the Medicare Prescription Drug Benefit Manual.
“Original Medicare does not cover Wegovy for weight loss, but you may request prior authorization if the medication’s primary use is related to your type 2 diabetes.“
This exclusion began in 2003 when dangers of specific weight loss drugs, such as Fen-Phen, were causing more harm than good. Original Medicare does cover weight loss counseling and certain bariatric surgeries for some people 65 and older who are obese.
If you’d like to use Wegovy, you must pay out-of-pocket.
Wegovy is a weekly injection, and the average cost for four weeks of Wegovy is between $1,500 and $1,800, depending on where you get your prescription. The annual cost is between $18,000 and $21,600.
Wegovy makes the following statement on its website, “Unfortunately, Medicare does not cover medicines for obesity. However, some select Medigap and Medicare Advantage plans for retirees do. If you have one of these plans, please check with its administrator.”
Currently, there aren’t any Medicare Advantage or Medicare Supplement plans that cover Wegovy. That’s because its primary use is weight loss. You must get prior authorization if you want coverage for Wegovy under your plan. With current regulations against weight loss medications, approval is unlikely unless it’s related to type 2 diabetes management.
If the out-of-pocket cost caused sticker shock and you don’t have type 2 diabetes, there’s still coverage hope.
In 2023, legislation was presented for allowing weight loss medications to be covered by Medicare—especially Novo Nordisk’s Ozempic and Wegovy. However, lifting the current restriction would cost Medicare and its beneficiaries dearly, but lobbies are working hard to make these medications more widely available.
If you’re enrolling in Medicare for the first time and have diabetes, Ozempic may be an option. This medication is similar to Wegovy, but its primary purpose is type 2 diabetes management and weight loss is an added benefit.
If you want to explore Ozempic coverage, tell your Connie Health agent. They can review whether there is a Medicare Advantage Prescription Drug plan or Medicare Part D prescription drug plan that offers coverage.
If you have more questions or want to change plans, our licensed agents can help you explore your Medicare Advantage plan choices.
Speak with a local licensed agent today—call (623) 223-8884. We’re here to support you throughout your Medicare journey.
No, Original Medicare Parts A and B, nor do Medicare Part D prescription drug plans cover Wegovy for weight loss. There also aren’t any Medicare Advantage Prescription Drug plans that offer coverage. This is because, since 2003, the FDA has restricted the coverage of medications used for weight loss.
Original Medicare Parts A, B, and Part D prescription drug plans do not cover Wegovy for weight loss. Nor do Medicare Advantage Prescription Drug plans.
Ozempic is covered by Medicare Part D and Medicare Advantage Prescription Drug plans for people with type 2 diabetes, but not for weight loss. In the case of Ozempic, weight loss is a side effect but not the primary purpose.
There are no FDA-approved drugs for weight loss covered by Medicare.
No, Medicare Part D and Medicare Advantage Prescription Drug plans do not cover Wegovy. There aren’t any medications prescribed for weight loss covered by Medicare.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.