Obesity Care and Weight Loss: What’s Covered, and What’s Not?

Nutrition counseling and therapy

Many insurance plans cover nutrition counseling by a registered dietitian or licensed nutritionist. Health plans may also cover medical nutrition therapy (MNT) for certain conditions, such as  Type 2 diabetes and chronic kidney disease. MNT focuses on using nutrition to manage specific health issues and minimize the risk of complications.

You may need a prescription or referral for nutrition counseling and therapy to get coverage. There may also be a limit on the number of covered nutrition visits. Check your insurance plan for requirements and to confirm what’s covered.

Medicare will cover obesity screening and behavioral counseling if you have a body mass index (BMI) of 30 or above. You must get the counseling from your primary care provider at their medical clinic or in another primary care setting.

Medicaid coverage for nutrition counseling and therapy varies by state and territory. Contact your local Medicaid office or visit the agency’s website to learn about covered services.

Weight-loss medications

Sometimes, lifestyle and behavioral changes aren’t enough to help you lose weight. Your healthcare professional may consider prescribing a weight-loss medication for you after discussing the risks and benefits. Weight-loss medications work in different ways. Some may help you feel less hungry or feel full sooner. Others make it harder for your body to absorb fat from the foods you eat.

Commercial health plans, including ACA and employer-sponsored plans, may cover the cost of prescription weight-loss medications. Check your plan details to find out whether these medications are covered. Weight-loss medication coverage may come with restrictions. You may need to have a certain condition to qualify. And prior authorization and/or step therapy may be required.

Medicaid coverage for weight-loss medications varies by state and territory. Plans that cover weight-loss medications may require enrollees to get prior authorization for coverage and/or impose quantity limits. Check your Medicaid plan for details.

Some examples of prescription weight-loss medications FDA approved for long-term use are:

• Contrave (naltrexone / bupropion)

• Foundayo (orforglipron)

• Qsymia (phentermine / topiramate)

• Saxenda (liraglutide)

• Wegovy (semaglutide)

• Xenical, Alli (orlistat)

• Zepbound (tirzepatide)

Medications through the Medicare GLP-1 Bridge program

Historically, Medicare hasn't covered medications prescribed for weight loss. But that changed in July 2026 with the Medicare GLP-1 Bridge program, a new pilot initiative that offers Medicare prescription plan enrollees access to weight-loss medications for a $50 monthly copay. Only certain GLP-1s are covered under the Medicare GLP-1 Bridge program, including all formulations of:

• Foundayo, an oral tablet

• Wegovy pills and injections

• Zepbound KwikPens

Medications through GoodRx for Weight Loss

If you're new to using GoodRx for weight-loss medication savings, you can pay an introductory price for the first two fills of certain forms and doses. You can pay $199 per month for Ozempic or Wegovy injections, or $149 for Wegovy pills or Foundayo pills. After the first two months, you may have to pay more per fill, depending on the medication and dose.

You can access Zepbound KwikPens starting at $299 per month through GoodRx. Subscribers to GoodRx for Weight Loss can also access other FDA-approved, brand-name GLP-1 medications.

Self-pay consumers can get Wegovy or Ozempic pills starting at $149 a month, or Wegovy or Ozempic pens starting at $199 a month, through NovoCare Pharmacy.

Surgery

Bariatric surgery is typically covered as a weight-loss option for people with a BMI of at least 40. You may also qualify if you have a BMI of 35 or above, have a qualifying medical condition or risk factors, and haven’t had success losing weight with diet changes and exercise.

Bariatric procedures change the stomach and small intestine to limit food intake and improve metabolism. The most common types of operations are:

• Biliopancreatic diversion with duodenal switch

• Gastric bypass

• Laparoscopic adjustable gastric banding

• Sleeve gastrectomy

Check with your insurance plan about coverage details. The average cost of bariatric surgery without insurance ranges from $7,400 to more than $30,000.

Medicare covers some bariatric surgical procedures, such as gastric bypass and laparoscopic gastric banding, for people who meet certain criteria. Most Medicaid programs cover some type of weight-loss surgery.

Other weight-loss interventions

One way to access help with weight loss is through the National Diabetes Prevention Program, a lifestyle change and support program for people at risk of Type 2 diabetes run by the CDC. You can participate in the diabetes prevention program online or at one of various locations around the country if you meet the eligibility requirements.

The Medicare Diabetes Prevention Program is available at no cost to Medicare enrollees. And there are other programs designed to help with weight loss or related conditions that you may have access to. For instance, if you live in a rural area or prefer a remote connection, you might try a virtual visit with a healthcare professional.

Some programs are free, but the costs vary. If the program you want to join has a fee, check with your insurer or your employer to find out if the program is covered by your health plan or a workplace wellness initiative.

CVS Caremark shift

A pharmacy benefit manager (PBM) is a company that works with health insurance plans, pharmacies, and pharmaceutical companies to administer prescription medication benefits. PBMs have many roles, including designing formularies — lists of preferred medications covered by health plans. Formularies are one tool that insurers use to manage pharmacy benefits offered to enrollees and control costs.

The largest PBMs — Cigna Express Scripts, CVS Caremark, and UnitedHealth Group’s Optum Rx — control 80% of the U.S. market. PBMs have a major influence on what’s listed on formularies, which affects prescription medication access for millions of people and determines what enrollees pay out of pocket. They also have the power to continuously update formularies, which means medications can be dropped and added throughout the coverage year.

For example, CVS Caremark dropped Eli Lilly’s Zepbound as a preferred medication in July 2025, but decided to continue covering Wegovy after negotiating a better price from its manufacturer, Novo Nordisk. But those prescribing and taking the medications reported that the treatments weren’t interchangeable. And studies show that people lose more weight with tirzepatide, Zepbound’s active ingredient, which is also approved to treat sleep apnea.

As a result, CVS Caremark announced that Zepbound will return to standard formularies in October 2026, which means 25 million to 30 million people may gain coverage.

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