Starting July 1, 2026, Medicare covers Wegovy, Zepbound, and Foundayo at a flat $50 per month through the GLP-1 Bridge demonstration — the same $50 regardless of dose or drug. But not everyone qualifies. Here is how to tell where you stand.

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. For a closer look at how a BMI under 35 plus a condition like heart failure, kidney disease, or pre-diabetes can still qualify you, see the conditions that lower your BMI cutoff.

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. For the full breakdown of which plans count — and the Extra Help catch — see is my plan eligible for the GLP-1 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.

What if you've already lost weight on a GLP-1?

Here is a point that confuses people: eligibility is judged based on your health when GLP-1 therapy first began, not your numbers today. So if you started a GLP-1 at a BMI of 35 and have since dropped below it, that starting point is what counts for the Bridge. Bring records that show where you began, not just where you are now. When you are ready, find a Medicare-friendly prescriber who can document it.