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💊 Medicare GLP-1 Bridge — Launches July 1, 2026

GLP-1 Eligibility Checker

Answer 3 quick questions to see if you may qualify for $50/month Wegovy or Zepbound coverage through Medicare.

BMI

Conditions

Medications

Results

Step 1 of 4

Let's check if you may qualify for Medicare GLP-1 coverage

Enter your height and weight — or your BMI directly — to get started.

Height

Feet

Inches

Weight

Pounds

Your BMI

Not sure? Calculate your BMI

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Your BMI

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Underweight
<18.5 Normal
18.5–24.9 Overweight
25–29.9 Obese
≥30 Severe
≥40

Please enter valid height and weight to continue.

Step 2 of 4

Health Conditions

Select all conditions that apply to you. These affect your eligibility pathway.

Type 2 Diabetes

Your blood sugar is too high and requires medication or insulin management

Cardiovascular Disease (Heart Disease)

History of heart attack, stroke, heart failure, or atherosclerosis (clogged arteries)

Sleep Apnea

Diagnosed obstructive sleep apnea — you stop breathing repeatedly during sleep

Hypertension (High Blood Pressure)

Your blood pressure is consistently above 130/80 mmHg, diagnosed by a doctor

High Cholesterol / Hyperlipidemia

Abnormal levels of cholesterol or triglycerides in your blood

None of the above

I don't have any of these conditions

Step 3 of 4

Current Medications

Are you currently taking any of these medications?

GLP-1 Medications

Wegovy (semaglutide — weekly injection)

FDA-approved for chronic weight management

Zepbound (tirzepatide — weekly injection)

FDA-approved for chronic weight management

Ozempic (semaglutide — weekly injection)

FDA-approved for type 2 diabetes

Mounjaro (tirzepatide — weekly injection)

FDA-approved for type 2 diabetes

Rybelsus (semaglutide — daily pill)

FDA-approved for type 2 diabetes

Trulicity (dulaglutide — weekly injection)

FDA-approved for type 2 diabetes

Compounded semaglutide or tirzepatide

From a compounding pharmacy — NOT FDA-approved brand-name

Are you currently taking insulin?

Yes No

💉

Diabetes GLP-1 Coverage (Already Active)

GLP-1 medications approved for type 2 diabetes (Ozempic, Mounjaro, Trulicity, Rybelsus, Victoza) are already covered under your plan's Part D formulary — no waiting for July 2026.

You may also qualify for the GLP-1 Bridge for weight management separately, which would cover Wegovy or Zepbound at $50/month starting July 1, 2026.

⚠️

About Your Compounded GLP-1

Compounded GLP-1 medications are not covered by Medicare and are not FDA-approved. If you qualify for the Medicare Bridge, transitioning to brand-name Wegovy or Zepbound at $50/month would give you a safer, FDA-approved option at a competitive price.

🩺

Doctor Visit Prep Checklist

Print this checklist and bring it to your next doctor appointment. Getting these items documented now prepares you for coverage starting July 1, 2026.

⏰ The GLP-1 Bridge opens July 1, 2026

Contact your doctor now to prepare your documentation.

📋 Diagnosis Codes Your Doctor Needs (ICD-10)

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E66.01 — Morbid (severe) obesity due to excess calories

Required for BMI ≥ 40 or BMI ≥ 35 with obesity complication

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E66.09 — Other obesity due to excess calories

For BMI ≥ 30; E66.9 (obesity unspecified) also accepted

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E11.x — Type 2 diabetes mellitus

E11.9 (without complications) or specific E11 subcode for your situation

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I10 — Essential (primary) hypertension

Needed if BMI 27–29.9 and hypertension is your qualifying condition

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I25.10 — Atherosclerotic heart disease / I63.x — Stroke

Use the specific code matching your cardiovascular diagnosis

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E78.x — Hyperlipidemia / dyslipidemia

E78.00 pure hypercholesterolemia, E78.5 hyperlipidemia unspecified

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G47.33 — Obstructive sleep apnea

Must be previously diagnosed; brings documentation of sleep study if available

🔬 Lab Results to Bring

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HbA1c (Hemoglobin A1C)

Needed if you have type 2 diabetes — shows 3-month blood sugar control

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Fasting blood glucose

Current glucose levels — supports metabolic syndrome documentation

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Lipid panel (cholesterol)

Total cholesterol, LDL, HDL, triglycerides — supports cardiovascular risk documentation

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Blood pressure reading

Recent measurements (ideally from multiple visits) if hypertension applies

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Current BMI measurement (from your doctor)

Must be documented in medical record — self-calculated BMI alone is not sufficient

📄 Clinical Documentation for Prior Authorization

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Prior weight management program attempts

Most plans require documentation of a structured weight loss attempt (supervised program, medical nutrition therapy, etc.)

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Qualifying condition documentation

Medical record entries confirming BMI ≥ 30 (or 27+ with comorbid condition)

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Cardiovascular risk documentation

Supports medical necessity — especially important for Wegovy's cardiovascular indication

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Insulin therapy documentation (if applicable)

Note: Some GLP-1 medications may reduce or eliminate need for insulin — discuss with your doctor

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Medicare Advantage plan card

Your plan's contact information for prior authorization submission

Generated at DMEHelper.com — Medicare GLP-1 Eligibility Checker

Visit dmehelper.com/glp1/eligibility for the interactive version. Learn more at dmehelper.com/glp1

This checklist is for educational purposes only and does not constitute medical advice. Eligibility is determined by your Medicare Advantage plan and prescribing physician.

Find the right Medicare Advantage plan

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💊 Find GLP-1 Friendly Plans 📖 Read Full GLP-1 Guide

This tool is for educational purposes only and does not constitute medical or legal advice. Actual eligibility is determined by your Medicare Advantage plan and prescribing physician. Coverage details are based on the Medicare GLP-1 Bridge program as announced; terms may change.