Weight loss is a common goal for many adults, with a significant portion actively trying to manage their weight. However, for Medicare recipients, navigating the landscape of weight loss programs and coverage can be complex. This article aims to provide a comprehensive guide to understanding Medicare's coverage of weight loss programs, services, and medications, and to clarify what options are available for those seeking to improve their health through weight management.
Understanding Medicare and Weight Loss
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), offers preventive services and screenings to help individuals maintain a healthy weight. However, it generally does not cover weight loss programs, services, or medications that are not deemed medically necessary. This means that services such as meal delivery programs, weight loss programs like Nutrisystem or Weight Watchers, and FDA-approved diet pills or medications are typically not covered and would require out-of-pocket payment.
However, there are exceptions. Original Medicare (parts A and B) provides preventive weight loss screenings and nutrition counseling if you meet the eligibility criteria.
Covered Weight Loss Services Under Medicare
While comprehensive weight loss programs may not be covered, Medicare does offer coverage for specific services that can aid in weight management under certain conditions:
Obesity Screenings and Counseling
If you have a Body Mass Index (BMI) of 30 or higher, Medicare covers obesity screenings and behavioral counseling. These services must be performed by your doctor or primary care physician in a primary care setting and include:
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- Obesity screening
- Dietary assessment
- Nutrition counseling
These services are considered preventive and are covered under Medicare Part B. If you've met your Part B deductible for the year, most of these services will cost you nothing out of pocket.
Nutritional Counseling (Medical Nutrition Therapy)
Doctors may recommend medical nutrition therapy (MNT) to treat and manage certain health conditions, such as diabetes or kidney disease. This therapy includes:
- Nutrition and lifestyle assessment
- Nutritional therapy sessions
- Lifestyle management
- Follow-up visits
Medicare will cover MNT if you have diabetes, kidney disease, or have had a kidney transplant within the last 36 months. People on dialysis can also receive MNT as part of standard care. MNT is considered preventive, so these services have no out-of-pocket cost. However, your doctor must refer you to a registered dietitian for counseling.
Bariatric Surgery
For individuals with severe obesity, bariatric surgery may be a medically necessary option for weight loss. Medicare covers bariatric surgery if you meet the following criteria:
- A BMI of 35 or higher
- At least one underlying health condition related to obesity
- Previous unsuccessful medical attempts at weight loss
Covered bariatric procedures include both malabsorptive and restrictive procedures, such as:
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- Roux-en-Y gastric bypass
- Biliopancreatic diversion with duodenal switch
- Adjustable gastric banding
- Sleeve gastrectomy
- Vertical gastric banding
If you meet the eligibility criteria, Medicare will cover bariatric surgery, but you will be responsible for standard Medicare plan costs, including any deductibles, copayments for doctor and specialist visits, and coinsurance for any procedures.
Medicare Advantage Plans and Weight Loss
Medicare Advantage (Part C) plans are offered by private insurance companies and provide the same benefits as Original Medicare (parts A and B). However, they often include additional benefits, such as:
- Fitness programs (e.g., SilverSneakers, Renew Active, Silver&Fit)
- Gym memberships
- Non-medically necessary weight loss programs
- Balanced, nutritious meal delivery
If you are interested in these additional benefits, it's essential to review the coverage offered by different Medicare Advantage plans in your area. Keep in mind that plans with this type of coverage might have additional costs. To stay enrolled in a Medicare Advantage plan, you must still pay the Part B premium directly to Medicare, although some plans may cover some or all of the Part B costs.
Weight Loss Medications and Medicare Part D
Medicare Part D prescription drug plans generally do not cover weight loss drugs or diet pills, including GLP-1 medications, when prescribed solely for weight loss. This exclusion applies even if a doctor prescribes the drug "off-label" for weight loss.
However, there are exceptions. 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, meaning a drug may be covered for one use but not for weight loss.
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For example, Medicare 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 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 may be covered when prescribed to treat obstructive sleep apnea in adults with obesity, if your plan lists it and criteria are met.
GLP-1 Receptor Agonists and Medicare
GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications that help control blood sugar and can also lower appetite. They work by signaling the pancreas to release insulin when needed, slowing how fast food leaves your stomach, and reducing sugar made by your liver. While doctors primarily prescribe them for Type 2 diabetes, some GLP-1 medications are also approved for weight loss.
GLP-1 coverage can feel complex. In 2025, Part D caps yearly out-of-pocket costs for covered drugs at $2,000. If a GLP-1 medication is covered for a specific condition (e.g., Type 2 diabetes), your costs will depend on your specific plan, the pharmacy you use, and whether your medication is covered for your diagnosis. Plans can have a deductible up to $590. You pay 100% for covered drugs until you meet it. After the Deduction - You generally pay 25% coinsurance for covered drugs until you reach the annual $2,000 out-of-pocket maximum. High-cost medicines are often on a "specialty" tier. Plans can set specialty-tier coinsurance between 25% and 33% depending on the plans deductible.
It's important to note that coverage and tiers vary by plan and state.
What to Do If Your Drug Is Not on the Drug List
If your prescribed medication is not on your plan's Drug List (formulary), you have several options:
- Ask your prescriber about alternatives on your plan’s Drug List.
- Inquire whether a formulary exception may be appropriate.
Programs to Help with Medication Costs
Many individuals qualify for Extra Help or state assistance programs that lower drug costs. Your pharmacist or plan can help you check your eligibility.
The Future of Medicare and Weight Loss Drugs
The Centers for Medicare & Medicaid Services (CMS) is exploring a pilot program 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.
Making Dietary and Lifestyle Changes
Even if your Medicare plan doesn't cover the weight loss services you're interested in, there are several dietary and lifestyle changes you can make on your own:
- Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, and healthy fats.
- Focus on lean protein and eat red and processed meats in moderation.
- Enjoy refined carbohydrates, such as sweets and soda, in moderation.
- Drink water often and make it your primary drink throughout the day.
- Find a diet that works for you in the long term, and avoid overly restrictive or dangerous fad diets.
- Always consult your doctor before making any major dietary changes.
The Importance of Addressing Obesity
Obesity is a serious health issue in older adults, linked to numerous health conditions and increased healthcare costs. A BMI of 30 or higher, considered obese, increases your risk for many health conditions, such as some cancers, coronary heart disease, type 2 diabetes, stroke and sleep apnea. Ideally, a healthy BMI should be between 18.5 and 24.9, but BMI isn't an entirely accurate measure of the weight you carry on your frame. For example, it doesn’t take into account how much fat you carry or where the fat is distributed, factors that can affect your metabolic health.
The American Medical Association (AMA) officially recognized obesity as a disease in 2013, highlighting the importance of treating it as a serious chronic condition.
Advocacy and Legislation
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. For example, 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.