Does Medicare Cover Ozempic, Wegovy or Zepbound in 2026?

Yes, temporarily. Medicare has long been barred by law from covering drugs used specifically for weight loss, so Part D plans could only cover GLP-1s for other conditions such as type 2 diabetes, cardiovascular risk or sleep apnea.3 The Medicare GLP-1 Bridge is a short-term CMS demonstration that works around that limit, running from July 1, 2026 to December 31, 2027.2 It was first planned to end on December 31, 2026, and CMS extended it after delays to the longer-term BALANCE model.2,6

You qualify for the Bridge if you are 18 or older, have Part D coverage, and meet one of three BMI-based tests.1

• A BMI of 35 or higher.1
• A BMI of 30 or higher with at least one of: diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher.1
• A BMI of 27 or higher with at least one of: prediabetes, a previous heart attack or stroke, or blocked arteries in the legs or arms.1

You are not eligible for the Bridge if you already get a GLP-1 covered through your Part D plan, or if you have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease.1 Those exclusions exist because your regular Part D plan may cover a GLP-1 for those conditions instead.1

Your prescriber must send the prescription to a pharmacy, complete a prior authorization when asked, and certify that you are using the drug alongside a diet and exercise program.1 Medicare says the prior authorization stays valid through December 31, 2027, including refills and dose changes, unless you switch to a different GLP-1.1

Yes, through the Bridge, but only the Zepbound KwikPen. Medicare.gov states that the program does not cover Zepbound single-dose vials or single-dose pens.1 Lilly lists Zepbound through the Bridge for no more than $50 a month for eligible Part D patients with a prescription for weight management.7

People searching "will Medicare cover Zepbound in 2026" should note that the Lilly Zepbound savings card is not an option on Medicare: it excludes anyone enrolled in Medicare, Medicare Part D, Medicare Advantage or Medigap.7 Lilly's Medicare section also lists self-pay starting at $299 a month for those who do not qualify for the Bridge.7 For full card and self-pay terms, see our Zepbound savings card guide.

Possibly, through your regular Part D plan rather than the Bridge. People with moderate-to-severe sleep apnea are excluded from the Bridge, and Medicare.gov notes that their Part D plan might cover a GLP-1 for that condition.1 Part D plans may cover GLP-1s for sleep apnea because it is a medical indication, not weight loss alone.3 Coverage, tier and prior authorization rules vary by plan, so check your plan's formulary.

Yes. All formulations of Wegovy, the injection and the tablet, are covered through the Bridge for eligible enrollees.1 Novo Nordisk lists a $50 monthly cost for all dose strengths of the Wegovy pen and pill for eligible Part D beneficiaries from July 1, 2026 through December 31, 2027.8 Part D plans may also cover Wegovy outside the Bridge for its cardiovascular risk-reduction indication.3

Medicare Part D plans can cover Ozempic when it is prescribed for type 2 diabetes, which is its approved use; Medicare has not been allowed to cover drugs prescribed specifically for weight loss.3 Ozempic is not on the Bridge's list of covered drugs, which names only Foundayo, Wegovy and the Zepbound KwikPen.1 So "will Medicare pay for Ozempic" depends on the diagnosis: with type 2 diabetes, your Part D plan's formulary and cost-sharing apply; for weight loss alone, the Bridge route is Wegovy, which contains the same active ingredient, semaglutide.

KFF lists Ozempic among the drugs eligible under the separate BALANCE model, but the Medicare Part D side of that model was indefinitely delayed after too few plans signed up.3

KFF reports that the negotiated net price behind the Bridge is $245 for a month's supply, with the enrollee paying $50.3 The $50 does not count toward Part D's $2,100 annual out-of-pocket cap, and people who get the Low-Income Subsidy cannot use it to reduce the copayment.5

What happens after December 31, 2027 is not settled. CMS had planned to hand coverage to the BALANCE model, but KFF reports that its Part D component was delayed indefinitely because it fell short of the participation needed.3 KFF has described a financially sustainable solution for covering obesity drugs in Medicare as still elusive.6

It depends on your state and your diagnosis. State Medicaid programs must cover GLP-1s for type 2 diabetes, for cardiovascular disease (Wegovy) and for moderate to severe sleep apnea in adults with obesity (Zepbound), but covering them for weight loss is optional.4

As of January 2026, 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service.4 California, New Hampshire, Pennsylvania and South Carolina ended that coverage, and North Carolina's coverage lapsed in October 2025 before being reinstated in December 2025.4 The BALANCE model's Medicaid track, which is voluntary for states, launched on May 1, 2026 and runs through December 31, 2031.3 Check your state Medicaid agency or managed care plan for its current list.

TRICARE For Life does not cover weight-loss drugs, but TRICARE points those beneficiaries to the Medicare GLP-1 Bridge, which covers certain weight-loss drugs from July 1, 2026.9 If you have Part D, the Bridge eligibility rules above apply.

Does Medicare cover Ozempic for weight loss? No. Ozempic is not in the Bridge, and Medicare cannot cover drugs used specifically for weight loss outside it. Part D plans can cover Ozempic for type 2 diabetes.1,3

How much is Zepbound with Medicare? Through the Bridge, $50 a month for the KwikPen if you meet the eligibility rules. Vials and single-dose pens are not covered.1

Can I use the Bridge if I have Medicare Advantage? Yes, if your Medicare Advantage plan includes drug coverage.1

Does Extra Help lower the $50 Bridge copay? No. Extra Help cannot reduce the Bridge copayment.1

When does the Medicare GLP-1 Bridge end? It is scheduled to run through December 31, 2027.2

Does Medicaid cover Wegovy for weight loss? Only in states that choose to cover it; 13 state programs did as of January 2026.4

If you do not qualify for the Bridge, compare self-pay options on our cheapest GLP-1 ranking and read GLP-1 cost without insurance. For current brand prices, see the Wegovy cost and Zepbound cost pages.

This article is for information only and is not medical, legal or financial advice. Medicare and Medicaid rules can change. Confirm your eligibility with Medicare (1-800-MEDICARE), your Part D plan or your state Medicaid agency, and talk to a licensed clinician before starting any medication.