Medicare’s Game-Changer: Will Weight-Loss Drugs Now Be Covered for Seniors?

For years, many weight-loss medications — especially those in the GLP-1 class like Ozempic and Wegovy — have been out of reach for most seniors on Medicare when used solely for obesity. Instead, coverage has been limited to diabetes or cardiovascular conditions. But that may be changing.

A recent deal announced by the current administration in partnership with major drugmakers promises to cut the cost of these medications for Medicare and open eligibility to certain obesity cases starting mid-2026. 

What’s Changing & Who’s Covered

Here are the key details of the announced changes:

Under the new agreement, Medicare will begin to cover GLP-1 weight-loss drugs for beneficiaries who meet specific obesity-related criteria — such as a body mass index (BMI) over 35, or those with obesity plus serious comorbidities like heart disease or kidney disease.

The cost of these drugs is dropping dramatically: manufacturers have agreed to a Medicare monthly price around $245, with beneficiary copays as low as $50 per month. Previously, list pricing ran well into four figures monthly.

This expanded coverage is set to begin via a pilot or phased rollout for mid-2026. Early access may be possible through a special portal or manufacturer program sooner.

Why This Matters

For seniors living with obesity who have struggled to access these medications because of cost or lack of coverage, this could be transformative.

Obesity is strongly linked with type 2 diabetes, heart disease, kidney disease and other chronic conditions — so improved access could reduce future health-care burdens.

From a policy perspective, this signals a shift: treating obesity not just as a lifestyle choice, but as a chronic disease deserving of serious medical and drug-coverage treatment.

What to Watch & Questions to Ask

1. Eligibility criteria
   You’ll need to check if your condition (BMI, comorbidities) meets the new definitions. Plans may vary.
2. Timing & rollout
   The full expansion isn’t immediate — expect mid-2026 for broad rollout, with earlier access via selected programs.
3. Out-of-pocket costs
   While copays will be low (≈ $50/month), you’ll want to verify coverage under your specific Medicare plan and formulary.
4. Plan limitations
   Different Medicare Part D or Advantage plans may adopt at different times or have varying rules — always check.

Lifestyle still matters    While drug access improves, these medications typically work best in conjunction with diet, exercise and medical supervision.

Take-Action Tips for Medicare Beneficiaries

• Contact your Medicare plan now: Ask about upcoming GLP-1 weight-loss drug coverage, eligibility criteria and timing for your region.
• Check your health status: If you have BMI > 35, or obesity plus a major health condition (heart, kidney, hypertension), keep documentation ready.
• Talk to your physician: Discuss whether a GLP-1 drug is clinically appropriate for you, and ask about future availability under Medicare.
• Plan financially: Even with lower copays, understand what your budget should anticipate and check if your Part D plan has restrictions or prior-authorization rules.
• Stay informed: These policies can evolve — new rules, plan options, and state‐by‐state variations may apply.

After years of waiting, Medicare’s move to cover weight-loss drugs for obesity could mark a major shift in U.S. public health and senior care. For eligible seniors, the combination of improved access, vastly lower costs and broader recognition of obesity as a serious disease could open a whole new chapter. But as always: check your eligibility, talk to your doctor, and plan ahead.