Are Ozempic and Other Weight-Loss Medications Covered by Insurance?

Medications prescribed for the purpose of treating obesity are rarely covered by Affordable Care Act (ACA) Marketplace plans or government-funded health care programs. That said, your health insurance will likely cover a weight-loss drug like Ozempic if it is prescribed for the treatment of another condition, such as diabetes.

Read below for an overview of when insurance covers weight-loss medication and what other obesity treatments may be covered by your health plan.

Key Takeaways The majority of Marketplace and work-based individual and family health plans don’t cover drugs prescribed exclusively to treat obesity. Weight-loss drug coverage is uncommon through Medicaid and is completely unavailable through Medicare, though it is more commonly available for military personnel insured by TRICARE. Even if your health insurance doesn’t cover medications prescribed solely for weight-loss purposes, it likely will cover a weight-loss drug prescribed to treat type 2 diabetes. Marketplace health plans are required to cover preventive services — like obesity screenings — at no charge to you, while also covering nutritional therapy and counseling. In 23 states, Marketplace plans must include coverage for weight-loss surgeries.

Does Insurance Cover Weight-Loss Medication?

Most health insurance companies do not cover weight-loss medications because they are not required to do so by the ACA. For example, a 2017 study that analyzed 136 Health Insurance Marketplace plans found that only 11% of the plans included some coverage for weight-loss drugs — and those plans were only available in nine of the 34 states included in the study.^[1]

Keep in mind that certain weight-loss drugs — like Ozempic and Mounjaro — have only been approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes, so your insurance likely won’t cover them if you merely want to take them to lose weight. Even FDA-approved chronic weight management drugs — like Wegovy and Zepbound — may only be covered if you have a comorbidity, such as high cholesterol or high blood pressure.^[2]

What Types of Health Insurance Cover Weight-Loss Medications?

There is no type of health insurance that universally covers weight-loss medications, but you may be able to receive coverage through various types of private or public health insurance plans. For example, weight-loss drugs may be covered by your Marketplace or job-based health plan. A 2024 study found that 18% of large businesses offering group health insurance to their employees covered GLP-1 agonists prescribed for weight-loss purposes.^[3]

Meanwhile, weight-loss medications are broadly covered by Medicaid in seven states.^[1] In addition, weight-loss medicines prescribed for both weight management and type 2 diabetes may be covered by TRICARE, a government-sponsored health insurance program for military personnel. However, your doctor will need to fill out a prior authorization form before TRICARE will cover your Wegovy, Zepbound, Ozempic or Mounjaro prescription.^[4]

Conversely, Medicare Part D expressly excludes coverage for medications prescribed solely for weight-loss purposes, meaning Medicare members should not expect to receive coverage for drugs like Wegovy or Zepbound. That said, you may be able to access broader coverage for weight management by purchasing a Medicare Advantage plan.^[5]

Regardless of whether your health insurance broadly covers weight-loss medicine, it is likely to cover drugs prescribed specifically to treat conditions like diabetes or cardiovascular disease.

What Medications Are Commonly Prescribed for Weight-Loss?

Below is a list of the drugs that have been approved by the FDA for the treatment of chronic weight management, along with their active ingredients:^[6]

• Wegovy (semaglutide)
• Zepbound (tirzepatide)
• Alli and Xenical (orlistat)
• Qsymia (phentermine-topiramate)
• Contrave (naltrexone-bupropion)
• Saxenda (liraglutide)
• IMCIVREE (setmelanotide)

Of course, other medications may also have the effect of suppressing your appetite and causing you to lose weight, including Ozempic and Mounjaro — which have the same active ingredients as Wegovy and Zepbound, respectively. While your doctor may prescribe these medications to help treat your obesity, your insurance may not cover them unless you also have a type 2 diabetes diagnosis.^[2]

How Do I Know if I Qualify for Weight Loss Medication?

In general, a doctor may prescribe a weight-loss drug for you if you have been unable to lose weight through diet and exercise alone and have a body mass index (BMI) over 30. You may also qualify with a BMI between 27 and 30 if you have an underlying health problem, like diabetes or high blood pressure.^[7]

What Weight Loss Treatments Do Insurance Companies Cover?

Even if your health insurance doesn’t cover weight-loss drugs, it may cover all or part of the costs for other services that can help you prevent or treat obesity.

Preventive Services

Marketplace health plans are required to cover obesity screenings for all plan members and type 2 diabetes screenings for adults ages 40 to 70 who are overweight or obese. Your insurance company must cover 100% of the costs for these preventive services, meaning you won’t have to pay anything out of pocket, even if you haven’t yet met your deductible for the year.^[8]

Similarly, Medicare Part B covers obesity screenings for Medicare members with a BMI of at least 30. These screenings come with no out-of-pocket costs as long as your doctor accepts Medicare and agrees to the Medicare-approved payment amount for the services.^[9] Medicaid and the Children’s Health Insurance Program (CHIP) may also cover obesity screenings, but the exact benefits offered by these programs vary by state.^[10]

Nutritional Therapy and Counseling

Health insurance coverage for nutritional therapy and counseling is generally similar to coverage for preventive screenings. For example, ACA health plans must completely cover obesity counseling for all policyholders and diet counseling for adults with a high risk of experiencing a chronic disease.^[8] Similarly, Medicaid and CHIP may cover counseling related to nutrition or physical activity, depending on the state you live in.^[10]

Meanwhile, Medicare Part B covers all of the costs for behavioral therapy sessions that include dietary assessments and counseling focused on improving diet and exercise. However, these sessions are only covered for Medicare members with a BMI over 30 who receive counseling from their primary care physician in a primary care setting, such as a doctor’s office.^[9]

Weight Loss Surgery

Although ACA health plans are not universally required to cover weight-loss surgeries, 23 states include bariatric surgery among the minimum essential benefits that all Marketplace plans in the state must cover.^[11] In some cases, your insurance carrier may require you to meet certain eligibility requirements before your weight-loss surgery will be covered, such as the following:^[12]

• Be more than 18 years old
• Have a BMI above 40 or have a BMI between 35 and 40 plus high blood pressure, type 2 diabetes or a similar comorbidity
• Prove that you have attempted to lose weight for an extended period of time
• Participate in an insurer-assigned weight-loss program
• Undergo a psychological examination
• Quit smoking before your surgery
• Not have a history of substance abuse
• Have been diagnosed with morbid obesity prior to your surgery

Medicare provides coverage for some types of weight-loss procedures for members with morbid obesity, including gastric bypass surgery and laparoscopic banding surgery.^[13] In addition, bariatric surgery is usually covered by Medicaid — however, as with many other benefits, coverage specifics vary on a state-by-state basis.^[14]

What Should I Do if Insurance Won’t Cover Weight Loss Treatments?

If your health insurance provider will not cover a certain weight-loss treatment despite your doctor’s recommendation, you may want to switch to a different plan during open enrollment or — if applicable — a special enrollment period. As you shop for a new plan, be sure to ask up front whether the plans you are interested in cover weight-loss surgeries or medications.

Alternatively, you could consider enrolling in a nonsurgical medical weight-loss program or using a resource like GoodRx to search for coupons for weight-loss drugs.

How To Get Insurance To Cover Weight-Loss Medication

After receiving a notice that your health plan won’t cover a certain weight-loss medication, you should reach out to your insurance company to see if there are any criteria you can meet to get the medicine covered. If you have insurance through work, you could instead ask your health care provider to send a letter to your employer explaining why you need a certain medication and requesting that your health coverage extend to that medication.

Ways To Save On Weight-Loss Medications

There are various ways to save money on medication if your insurance won’t cover a weight-loss drug prescribed by your doctor, such as the following:^[15][16]

• Drug coupons from providers like GoodRx
• Savings cards issued by drug manufacturers
• Tax-advantaged money deposited into a health savings account (HSA) or flexible spending account (FSA)
• Patient assistance programs designed for people with little or no insurance coverage