Obesity is a serious health issue with far-reaching consequences beyond physical appearance, including increased healthcare costs and risks for various diseases. The good news is that obesity is treatable, and Medicare offers some coverage for weight loss treatments. This article provides a detailed overview of Medicare-approved weight loss programs, eligibility criteria, covered services, and potential future changes.
The Scope of Obesity and Its Impact
Obesity is a prevalent issue, and its consequences extend beyond aesthetics. It is linked to added costs and poses significant health risks, including heart disease, type 2 diabetes, stroke, sleep apnea, and certain cancers. Recognizing obesity as a serious chronic condition is the first step toward effective treatment and management.
Medicare Coverage for Weight Loss: An Overview
Medicare acknowledges the importance of addressing obesity and covers certain treatments. However, coverage is not comprehensive, and many common weight loss interventions are not fully covered.
Intensive Behavioral Therapy (IBT)
Medicare Part B covers Intensive Behavioral Therapy (IBT) for obesity. To qualify, individuals must have a Body Mass Index (BMI) of 30 or higher. IBT includes dietary assessments and diet and exercise counseling. However, Medicare only covers appointments that take place in a primary care setting. Additional weight loss services, such as consultations with a dietitian, may incur extra costs. Medicare covers counseling sessions for months seven through 12 if you’ve lost at least 6.6 pounds by your six-month appointment.
Bariatric Surgery
In cases of severe obesity (BMI of 35 or higher) with at least one underlying obesity-related health condition, such as diabetes or heart disease, Medicare covers bariatric surgery if deemed medically necessary by a doctor. Patients typically need to demonstrate prior unsuccessful efforts to lose weight through diet and exercise to secure coverage. One common bariatric surgical procedure covered by Medicare is Roux-en-Y gastric bypass surgery, which reduces the stomach to a small pouch, inducing a feeling of fullness even after eating small meals. Part A covers bariatric surgery for people with a BMI of 35 or higher and a related health condition, like diabetes or heart disease.
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However, some bariatric procedures, such as open sleeve gastrectomy and gastric balloon, are specifically excluded by Medicare.
Nutritional Counseling
Part B will pay for a nutritionist for people with diabetes, kidney disease, or those who have undergone a kidney transplant in the past 36 months. Part A might cover these services during a hospital stay.
What Medicare Doesn't Cover
Despite covering some obesity treatments, Medicare has limitations in its coverage.
Weight Loss Programs and Services
Medicare typically does not cover weight loss programs such as fitness or gym memberships, meal delivery services, or programs like Nutrisystem or Weight Watchers. These are often considered "lifestyle enhancement services" that support overall health but do not directly treat a specific medical condition.
Anti-Obesity Medications (AOMs)
Anti-obesity medications (AOMs), or pharmacotherapeutics, are not covered by the Medicare Part D prescription drug benefit, even though they are increasingly recognized as an effective option for some people. This non-coverage creates a gap in the continuum of care, as drug therapy is a key treatment component for certain groups of older adults living with obesity.
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However, Medicare does cover weight-loss drugs when they're prescribed for other conditions approved by the FDA. For example, Medicare covers Ozempic, the semaglutide injectable drug used to treat type 2 diabetes, but it won't cover the drug when it's only prescribed for weight loss.
Medicare Advantage (Part C) Plans
Medicare Advantage (Part C) plans, offered by private insurance companies, provide the same benefits as Original Medicare (Parts A and B) and often include additional benefits that can support weight loss efforts. These expanded supplemental benefits may include gym memberships, non-medically necessary weight loss programs, balanced, nutritious meal delivery, or fitness programs like SilverSneakers.
Before enrolling in a Medicare Advantage plan, it's essential to review the coverage it provides for weight loss programs. A person can find the plans available in their area on Medicare.gov.
Costs Associated with Medicare Coverage
For services covered by Original Medicare, expenses include premiums, deductibles, and coinsurance. In 2025, after reaching the annual Part B deductible of $257, Part B covers 80% of the cost of eligible outpatient treatments or services. The Part B premium starts at $185 but can increase depending on a person’s income.
Most people do not pay a premium for Part A inpatient care, but they must meet a deductible of $1,676 in 2025. Once a person has met the deductible, Part A may cover a person’s hospital stay, surgical procedure, and any necessary inpatient services for up to 60 days. After 60 days, a person must pay an incremental copayment.
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Medicare Advantage plans have different premiums, deductibles, and coinsurance, depending on the plan. To stay enrolled in a Medicare Advantage plan, a person must still pay the Part B premium directly to Medicare, although some plans may cover some or all of the Part B costs.
Advocacy and Future Changes
Certain advocacy groups, such as the Obesity Action Coalition (OAC), are working on legislation to broaden access to treatment options for Medicare beneficiaries affected by obesity. The Treat and Reduce Obesity Act (TROA) is a bipartisan bill designed to enable CMS to clarify that FDA-approved anti-obesity medications may be covered under Part D.
The Centers for Medicare & Medicaid Services (CMS) is exploring a pilot that could allow some Medicaid programs and Part D plans to cover GLP-1 drugs for “weight management,” with potential Medicare availability in 2027. Details are not finalized and would go through public processes.
Understanding GLP-1 Coverage
GLP-1 medicines help your body control blood sugar and can lower appetite. They signal your pancreas to release insulin when needed, slow how fast food leaves your stomach and reduce sugar made by your liver. Doctors mainly prescribe them for Type 2 diabetes. Weight-loss-only prescriptions are excluded from Medicare Part D coverage. This includes drugs whose only use is weight management.
If a medication has an FDA-approved indication beyond weight loss, Part D plans may cover it for that specific use. Coverage decisions are indication-specific. A drug may be covered for one use but not for weight loss. If prior authorization is needed, start with your doctor. Your plan reviews the request and sends a decision to you, your doctor, and your pharmacy. If step therapy applies, you may need to try a covered alternative first.
Eligibility for Medicare-Covered Weight Loss Treatments
To be eligible for Medicare-covered weight loss treatments, the patient's body mass index (BMI), an estimate of body fat based on the individual’s height and weight, must be 30 or higher. A BMI of 30 or higher increases the risk for many health conditions such as certain cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea.
To qualify for Medicare coverage of bariatric procedures, you must have a body mass index of 35 or higher and at least one other condition related to obesity, such as diabetes or heart disease.
Navigating Weight Loss Drug Coverage
Medicare Part D excludes drugs used for weight loss.
Ozempic
Medicare Part D plans may cover Ozempic, when it’s prescribed for Type 2 diabetes and listed on your plan’s Drug List (formulary). It is not covered for weight loss. Always check your plan for prior authorization, step therapy or quality limits.
Wegovy
Wegovy may be covered only when prescribed to reduce cardiovascular risk in adults with established cardiovascular disease who are overweight or obese, and only if your plan lists it on the Drug List.
Zepbound
Zepbound may be covered when prescribed to treat obstructive sleep apnea in adults with obesity, if your plan lists it and criteria are met.
What If Your Drug is Not on the Drug List?
Ask your prescriber about alternatives on your plan’s Drug List or whether a formulary exception may be appropriate.
Programs to Help with Medication Costs
Many members qualify for Extra Help or state assistance programs that lower drug costs. Your pharmacist or plan can help you check your eligibility.