The three ways to qualify

The Medicare GLP-1 Bridge uses a tiered system based on body mass index (BMI), plus a qualifying health condition at the lower BMI levels. You generally qualify if you meet one of these, and your eligibility is judged based on your health when GLP-1 therapy first began:

  • Tier 1 — BMI 35 or higher. No additional condition required.
  • Tier 2 — BMI 30 or higher with one of: heart failure, uncontrolled high blood pressure, or chronic kidney disease.
  • Tier 3 — BMI 27 or higher with one of: prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.

Type 2 diabetes, sleep apnea, and high cholesterol are not on the Bridge's qualifying-condition list for weight-loss use.

You also need Part D coverage

Beyond the BMI tiers, you must be enrolled in a Medicare drug plan — either a standalone Part D plan or a Medicare Advantage plan that includes drug coverage (MA-PD). Original Medicare with no drug plan cannot use the Bridge.

Your doctor files the prior authorization

Even if you clearly meet a tier, coverage is not automatic. Your prescriber documents your BMI and conditions and submits a prior authorization to CMS (not to your own plan). CMS approves, denies, or asks for more information. Bring documentation of your weight history and health conditions to your appointment to make this go smoothly.

Check where you might land

The fastest way to get a plain-English read is our free quiz — it walks through your Part D status, calculates your BMI, and asks about the qualifying conditions:

Take the 2-minute eligibility quiz →

For the complete rules and the prior-authorization steps, see the Medicare GLP-1 guide. And if it turns out you do not qualify, you still have options — see what to do if you do not qualify.

The quiz and this article give a general estimate, not a guarantee. Only CMS and your plan can confirm your eligibility.