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Dear Connie,
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
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Local, licensed insurance agents with 25+ years of experienceDear Judith,
This is a great question; 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. Currently, no Medicare Advantage or Medicare Part D plans cover Wegovy for 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.
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.
You must pay out-of-pocket if you’d like to use Wegovy for weight loss.
Wegovy is a weekly injection, and the average cost for four weeks of Wegovy is between $1,350 and $2,000, depending on where you get your prescription. The annual cost is between $16,200 and $24,000.
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.”
Agent tip:
“Original Medicare does not cover Wegovy for weight loss, but you may request Part D or Medicare Advantage prior authorization if the medication’s primary use is to reduce the risk of heart attack or stroke for Medicare beneficiaries with cardiovascular disease who are overweight or obese.“
In March 2024, Medicare Part D and Medicare Advantage plans began covering Wegovy for select circumstances. Medicare Part D and select Medicare Advantage plans will cover Wegovy to reduce the risk of heart attack or stroke for Medicare beneficiaries with cardiovascular disease who are overweight or obese.
If you have cardiovascular or heart disease, Wegovy may be covered under Medicare Part D or your Medicare Advantage plan. The average out-of-pocket expense is $325 to $430 monthly, but your prescription costs would be capped at $2,000 in 2025. If you want help exploring Medicare Part D and Medicare Advantage plans that cover Wegovy, call (623) 223-8884 and speak with a local licensed Connie Health agent.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceIf the out-of-pocket cost caused sticker shock and you aren’t at risk for cardiovascular disease, 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 a Medicare Advantage Prescription Drug or Medicare Part D prescription drug plan offers coverage.
If you have more questions or want to change plans, our licensed agents can help you explore your Medicare Advantage plan and Medicare Part D 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 Food and Drug Administration (FDA) has restricted the coverage of medications used for weight loss.
In March 2024, the FDA approved Wegovy as a way to reduce the risk of heart attack or stroke for people with cardiovascular or heart disease who are overweight or obese. Because of that ruling, Medicare Part D and Medicare Advantage plans began covering Wegovy for this use. If you have cardiovascular disease and are overweight, you can now get Wegovy. The primary purpose is to reduce the risk of heart attack and stroke, but weight loss would be an additional benefit.
If you would like help reviewing Medicare Advantage or Medicare Part D plans that include Wegovy coverage, call (623) 223-8884 and speak with a local licensed Connie Health agent. We can help you find the coverage that you’re seeking.
There are no FDA-approved drugs for weight loss covered by Medicare.
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.
In 2024, the Food and Drug Administration (FDA) approved Wegovy as a way to reduce the risk of heart attack or stroke for people with cardiovascular disease who are overweight or obese. If you have cardiovascular disease and are overweight, you can now get Wegovy covered by select Medicare Part D and Medicare Advantage plans. The primary purpose is to reduce the risk of heart attack and stroke; weight loss would be an added benefit.
If you would like help reviewing Medicare Part D and Medicare Advantage plans that include Wegovy coverage, call (623) 223-8884 and speak with a local licensed Connie Health agent. We can help you find the coverage that you’re seeking.
No, Medicare Part D and Medicare Advantage Prescription Drug plans do not cover Wegovy for weight loss. There aren’t any medications prescribed for weight loss covered by Medicare.
There is one expectation. In March 2024, the Food and Drug Administration approved Wegovy for the reduction of stroke and heart attack for people with cardiovascular disease who are overweight or obese. Now, Medicare Part D and Medicare Advantage plans will cover Wegovy for this purpose. The primary reason to get the prescription is for the reduction of the risk of heart attack and stroke, and weight loss would be an added benefit.
Want help reviewing Medicare Part D, or Medicare Advantage plans that include Wegovy coverage? Call (623) 223-8884 and speak with a local licensed Connie Health agent. We can help you find the Wegovy coverage that you’re seeking.
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.
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