As a general rule, Medicare does not cover Wegovy since it’s an obesity medication, and Medicare doesn’t typically cover that category of drugs. This refers to Original Medicare, as well as private insurance plans like Medicare Part D and Medicare Advantage. Unfortunately, none of them will cover Wegovy.  

Why doesn’t Medicare cover Wegovy?

When Medicare was created, weight loss medications were considered ineffective and often dangerous. Because of this, they were explicitly excluded from the program. Since Wegovy is FDA-approved only for weight loss, Medicare is not allowed to cover this drug. 

So, Medicare beneficiaries looking to use Wegovy for weight loss purposes will likely face significant out-of-pocket costs, as Medicare simply does not cover any obesity medication​​​​.|

Does Medicare Part D cover Wegovy?

It’s always a good idea to check with your specific Part D plan, as they can sometimes surprise you with their coverage, but Part D typically does not cover Wegovy.

Does Medicare Advantage cover Wegovy?

Medicare Advantage Plans, or Part C are offered by private companies, and they can come with some extra perks not found in the standard package. This leads many to believe that Wegovy might be covered as part of those extra benefits. However, this is not a guarantee and most plans will not cover it. It’s essential for individuals to contact their plan providers to understand the specific coverage details regarding Wegovy​​​​​​.

Does Medicare cover Wegovy for diabetes?

If you’re eyeing Wegovy for diabetes treatment, not weight loss management, the news still isn’t great. Medicare Part D doesn’t cover Wegovy for diabetes either, sticking to its policy against weight loss drugs. 

That said, some Medicare Part D and Medicare Advantage plans might offer coverage for medications that treat overweight or obesity, potentially including Wegovy. Yet, this would be an exception rather than the norm​​.

Wegovy alternatives: does Medicare cover Ozempic?

As of 2023, Medicare has adapted its coverage options to include Ozempic, a crucial medication for managing Type 2 diabetes. While this represents a significant step forward in diabetes care for Medicare beneficiaries, understanding the nuances of this coverage is key to maximizing your benefits and managing your health effectively.

Ozempic is another formulation of semaglutide like Wegovy; however, Ozempic typically has less semaglutide than Wegovy, reflecting its primary origin as a diabetes drug. 

Medicare often includes Ozempic, but only for its FDA-approved use in treating Type 2 diabetes. According to Medicare’s “Coverage of Diabetes” handbook, however, Medicare Part D drug plans “can” cover Ozempic, but there is no guarantee. It’s crucial to check your plan’s formulary (the list of covered drugs) to confirm Ozempic inclusion​​​​.

Non-drug therapies for weight loss covered by Medicare

Medicare provides several therapeutic options for weight loss, which include various programs, therapies, screenings, and surgeries, though it has specific coverage limitations for weight loss medications.

Screenings and Counseling: Medicare Part B covers obesity screenings and behavioral therapy for beneficiaries with a BMI of 30 or more. This includes an initial BMI screening, dietary assessments, and counseling focusing on diet and exercise for weight loss​​​​.

Bariatric Surgery: Medicare covers certain types of bariatric surgeries, such as Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch, for beneficiaries who meet specific criteria, including having a BMI of 35 or higher, at least one obesity-related co-morbidity, and a history of unsuccessful medical treatment for obesity​​.

Diabetes Screenings and Prevention Program: Medicare Part B covers diabetes screenings for individuals at risk for diabetes or diagnosed with pre-diabetes. Additionally, Medicare covers participation in the Medicare Diabetes Prevention Program under certain conditions, such as having a BMI of 25 or higher (23 or higher if Asian), no previous diagnosis of diabetes or End-Stage Renal Disease, and specific blood sugar levels​​. 

Nutrition Therapy: Medicare Part B covers medical nutrition therapy for beneficiaries with diabetes or kidney disease, as well as those who have had a kidney transplant within the past 36 months. This therapy includes a nutrition and lifestyle assessment, nutritional therapy sessions, and follow-up visits​​. 

Wrapping up: Wegovy and Medicare

Medicare’s approach to weight loss treatments is a bit of a patchwork. The program generally doesn’t cover weight loss medication like Wegovy but does offer no-cost obesity screenings and behavioral counseling for those with a high BMI. Some Medicare Advantage plans might throw in extra benefits like gym memberships or fitness programs, and in cases of severe obesity, Medicare covers certain types of bariatric surgery. It also covers Ozempic for diabetes treatment.

There’s a buzz about potentially expanding Medicare to include FDA-approved weight loss meds. A bipartisan coalition in Congress and advocates are pushing for this change, emphasizing the need for a wide range of treatments for managing weight in older adults. Stay informed and keep exploring your options!