Will Insurers Cover Wegovy and other GLP-1 drugs if Medicare Expands Access?
November 3, 2025

There is a general truth in the health insurance sector: If Medicare and Medicaid are given the green light to cover a certain drug, insurers in the group health and individual health insurance market usually follow suit.


The Centers for Medicare and Medicaid Services (CMS) typically allows Medicare drug plans and Medicaid to cover a drug once the Food and Drug Administration approves it for specific conditions. However, despite the FDA's approval of popular-yet-pricey GLP-1 drugs like Wegovy, Ozempic, and Zepbound for weight loss, these programs do not cover them due to a long-standing rule not to cover anti-obesity medications (AOMs)


In 2024, CMS issued a proposed rule that would cover AOMs used solely for weight loss.  However, in April 2025, CMS finalized the proposed rule but did not include coverage for AOMs solely for weight loss in the final rule.  CMS stated it would continue to review AOMs and may revisit coverage in the future.


If CMS finalizes the rule, will group health and individual health insurers follow suit? 


Current Medicare GLP-1 coverage


Medicare, through Part D drug plans, and Medicaid already cover GLP-1s for certain conditions, including:

  • Type 2 diabetes, and
  • Cardiovascular disease.
  • Currently, some states cover GLP-1 drugs and AOMs under Medicaid.


After the government programs began covering the medications for the above conditions, private insurers have largely done the same.


The drugs approved for these conditions include:

  • Ozempic
  • Mounjaro
  • Rybelsus
  • Wegovy

 

The fine print


Experts say that if CMS approves GLP-1s and other AOMs for weight loss, private health insurers would likely do the same. However, this does not mean they would cover them outright. Each plan's copays, deductibles, and coinsurance would still apply, as they do for all other drugs.


The list price of these drugs is around $1,000 a month or more, though some manufacturers offer savings programs that significantly reduce the cost to patients.. Since GLP-1s and AOMs are expensive specialty drugs, insurers would likely put them in their pharmaceutical fee schedule's most expensive tier, meaning that enrollees would pay higher copays and/or coinsurance than for lower-tier drugs.


Additionally, health plans that decide to cover these drugs may require plan enrollees to first try less expensive treatments and/or lifestyle changes before approving a GLP-1 prescription.

 

Effect on costs


The rising cost of specialty drugs are contributing to overall premium inflation.


In 2023, health insurance outlays for prescription drugs increased by 10.8%, compared to 2.6% for all medical expenses, according to the U.S. Department of Health and Human Services. This increase was driven by brand-name and specialty drugs, particularly those used to treat diabetes and weight loss, such as GLP-1 drugs. If more insurers start covering these popular drugs, it would likely affect premiums.


However, there could be offsetting cost benefits. Consider that:


  • These drugs often result in a significant drop in blood-sugar levels, reducing the risk of diabetes-related complications.
  • GLP-1s yield an average weight loss of 15 to 20%, and about one-third of users lose approximately 10% of their body weight, according to a study.
  • Multiple studies have shown that they can reduce the risk of cardiovascular events, including heart attack and stroke.
  • There is growing research to determine if GLP-1s address other health conditions besides diabetes and heart disease. 
  • The drugs may help people cut back on drinking, according to a study published in JAMA.


Conclusion

The future of Wegovy and other GLP-1 weight-loss drugs in Medicare coverage remains uncertain—but if CMS eventually expands access, private insurers will likely follow. Still, high costs, strict utilization rules, and placement in expensive drug tiers could shape how coverage is offered. For patients, this means progress toward broader access is possible, but planning ahead for out-of-pocket costs will remain essential. Staying informed—and working with a trusted advisor—can help you navigate these changes as the coverage landscape continues to evolve.

Two smiling people lying on blanket in fall leaves. One in purple, one in orange.
By Kevan Brooks December 22, 2025
Vision and dental coverage are often overlooked, but they’re key to preventing bigger health issues and costs. Learn why adding them to your plan matters.
Family gathered around a kitchen table, smiling. Food and wine on the table.
By Kevan Brooks December 15, 2025
Make the most of the holiday season with simple, healthy habits for eating, drinking, exercise, and stress relief. Enjoy the festivities without sacrificing your well-being.
Person in red shirt being assisted by someone in a blue jacket; bandage on wrist, hand on chest.
By Kevan Brooks December 8, 2025
With rising deductibles and soaring medical inflation, even strong health insurance may not be enough. Learn how supplemental plans can help protect your finances in 2026.
Couple reading books together outdoors at a table, pointing at pages. Stack of books nearby.
By Kevan Brooks November 24, 2025
Want a simple, science-backed way to boost your health? Try reading! Discover how just 6 minutes of reading can cut stress by 68%, support brain function, and improve sleep and mood.
Woman reading a book in a forest, leaning against a tree with her bare feet up.
By Kevan Brooks November 17, 2025
Medicare mental health coverage is expanding in 2025! Learn about the new access to LPCs and MFTs, continued telehealth support, Intensive Outpatient Programs (IOPs), and the $2,000 Part D drug cap.
By Kevan Brooks November 11, 2025
You Can Have Both VA and Medicare Coverage
Two women with a pink ribbon on a pink background, supporting breast cancer awareness.
By Kevan Brooks November 10, 2025
October is Breast Cancer Awareness Month. Learn why early detection is critical and discover the supplemental insurance options (like Cancer, Critical Illness, and Disability plans) that offer crucial financial protection.
By Kevan Brooks November 4, 2025
Why Dental and Vision Coverage Is Often Overlooked
By Kevan Brooks November 3, 2025
Lung Cancer Screening
By Kevan Brooks October 31, 2025
As October’s chill sets in and jack-o'-lanterns light up neighborhoods across the country, excitement builds for one of the most cherished holidays of the year: Halloween. For children, it’s a night of costumes, candy, and creepy fun. For parents and guardians, however, it’s also a time to be extra vigilant. As we enter the 2025 Halloween season, it’s important to embrace both the fun and the responsibility that come with it. Here’s how to ensure Halloween night remains safe, magical, and memorable for everyone involved. Costumes: Safety First, Style Second Costumes are the heart of Halloween fun, but they should be as safe as they are spooky. When choosing or crafting a costume this year, opt for bright colors or incorporate reflective tape to improve nighttime visibility. While all-black outfits or elaborate disguises can look cool, they make it harder for drivers to spot pedestrians, especially in dimly-lit areas. Make sure costumes fit properly. Oversized robes, capes, or trailing accessories can pose tripping hazards. Masks should fit comfortably and allow for clear vision and easy breathing. In fact, face paint is often a safer and more comfortable alternative. Flame-resistant materials are also essential. Between decorative candles, bonfires, and carved pumpkins, fire risks are real. Avoid long, flowy fabrics and always check labels for safety certifications. Trick-or-Treating: Planning Makes Perfect Trick-or-treating remains a favorite Halloween tradition, but it requires thoughtful planning. Parents should accompany younger children and pre-teens, sticking to familiar, well-lit neighborhoods. Older kids who go out on their own should travel in groups, carry a phone, and establish clear rules about where they’ll go and when they’ll return. Before heading out, review basic pedestrian safety: use sidewalks, cross streets at intersections, and never dart between parked cars. Carrying a flashlight or wearing glowsticks can further improve visibility. And while it’s tempting to run from house to house, encourage kids to walk—there’s plenty of time for fun without risking injury. Candy Checks and Allergy Awareness Once the treats are collected, it’s time to sort through the haul. Parents should inspect all candy and snacks for signs of tampering, including torn wrappers, unfamiliar branding, or anything that looks homemade (unless it’s from a trusted source). Discard anything suspicious, as well as anything that’s not age-appropriate for your child. For children with food allergies, extra caution is needed. Many popular candies contain common allergens like nuts, dairy, or soy. Look for allergy-friendly options, and consider participating in the Teal Pumpkin Project, which promotes non-food treats like stickers or small toys for inclusive trick-or-treating. Homeowners: Make Your Property Trick-or-Treater Friendly If you're handing out treats this year, take a few steps to make your property safe and welcoming. Clear walkways of leaves, hoses, or decorations that might trip children. Keep your porch well-lit and avoid using real candles in pumpkins—battery-operated lights offer a safer alternative without sacrificing ambiance. If you have pets, make sure they are securely indoors or restrained. Even the friendliest dogs can become frightened or overly excited by costumes and doorbell rings. Embracing Tech and Trends In 2025, Halloween has taken a digital twist in many neighborhoods. Some communities are using apps to track trick-or-treat routes, schedule trunk-or-treat events, or create interactive haunted house maps. Parents can use GPS tracking apps to keep tabs on older kids, and many smart doorbells now allow you to monitor activity at your home remotely. While tech adds convenience and peace of mind, it should complement—not replace—real-world supervision and communication. A Final Word Halloween should be full of laughter, imagination, and shared joy. With a little preparation, a touch of common sense, and an eye on safety, 2025’s festivities can be both thrilling and secure. Whether you're donning a costume, handing out treats, or watching your little ghouls roam the night, remember: the best memories are made when everyone stays safe. Happy Halloween! 🎃
Show More