Ask the plan what it will pay.

The reason for treatment matters.

Medicare provides its prescription drug benefit through Part D.

As of September 2026, ordinary Part D coverage excludes medicines when used for weight loss. [a]

Another accepted medical use may allow coverage of that medicine, though payment by your particular plan is not assured. [a]

Ask the plan about the exact medicine, use, and required approval steps.

The temporary Bridge has separate rules.

GLP-1 is a hormone, a chemical signal, linked to appetite and blood sugar; medicines that act like it include semaglutide and tirzepatide.

The Medicare GLP-1 Bridge charges eligible participants $50 per month’s supply for certain weight-loss medicines as of September 2026. [b]

The programme runs from July 2026 through December 2027, outside the usual Part D payment system. [b]

The September 2026 terms exclude this copay from the amount counted against Part D’s annual cap on patient spending. [b]

The September 2026 rules set 18 as the minimum age and list no upper age limit, so age 80 alone does not exclude you. [b]

For the weight test, height and weight determine a figure called body mass index (BMI).

Under these rules, no extra qualifying condition is needed to meet the weight test when your BMI is 35 or more. [b]

At a BMI of 30 or more, the extra condition must be one of these: [b]

• Heart failure with preserved ejection fraction: each heartbeat pumps a normal share of the blood held in the heart.
• High blood pressure that remains high despite two medicines, using the programme’s exact blood-pressure limits.
• Kidney disease graded stage 3a or later for severity.

For a BMI of 27 or more, another condition must be present: pre-diabetes (early blood-sugar problems), a past heart attack or stroke, or symptomatic artery disease affecting the arms or legs. [b]

The weight and health tests apply to when this treatment began; the programme’s detailed rules set the exact blood-pressure and kidney-disease limits. [b]

The September 2026 rules require a participating Medicare drug plan, a prescription, approval before payment, and ongoing changes to food and physical activity. [b]

The September 2026 rules keep people who have type 2 diabetes outside the Bridge; their coverage is considered under ordinary Part D. [b]

Other exclusions include moderate or severe sleep apnea (repeated pauses in breathing during sleep), a specific liver disease with significant scarring, and having received a GLP-1 medicine through Part D during 2026. [b]

Open the Medicare agency · Bridge eligibility and products link in Page note [b] for the full rules. Ask your prescriber and the plan to compare your diagnosis, your BMI at the start of treatment, and your plan type with those rules.

Ask what approval involves.

Prior authorisation means a request for payment approval before the medicine is filled. [a]

• Which use and product does the plan cover?
• Who submits the request and supporting records?
• What will I pay if the request is approved?
• What happens if it is declined?
• Which visits or tests have separate charges?

Check health-account rules before paying.

Money set aside before tax for eligible medical expenses can be held in a health savings account (HSA) or a flexible spending arrangement (FSA). [c]

The US tax agency is the Internal Revenue Service (IRS).

As of September 2026, IRS guidance distinguishes treatment of a diagnosed disease from spending merely to improve general health. [c]

Ask your account administrator which records it needs for the proposed expense.