Does Medicare Cover Weight Loss Medications? 

Maintaining a healthy weight is important, especially as you get older. Many seniors find that excess weight compounds mobility issues as they age. These challenges make it even more important to consult with your doctor to find a diet and exercise plan that works for you.

Weight loss options when diet and exercise are not enough

For some seniors, however, lifestyle and nutrition alone are not enough. Some people have metabolic conditions that make it difficult to lose weight and keep it off, and the aforementioned mobility challenges can make it difficult to lose weight due to inactivity.

Seniors who have found themselves facing challenges in losing weight may be prescribed weight loss medications or may choose to use over-the-counter weight loss drugs. Some drugs have shown success in helping people lose weight with minimal side effects.

Does Medicare cover weight loss medications?

If you’re 65 or older and a recipient of Medicare benefits, you may be interested to know Medicare’s stance on weight loss drug coverage. Medicare benefits cover a wide array of healthcare items, including doctor visits, surgery and hospital admission, so it would make sense that the program would supply coverage for weight loss medications.

Unfortunately, Medicare does not cover weight loss drugs. This is because Medicare coverage is only available for healthcare items that the Centers for Medicare & Medicaid Services deems “medically necessary.” Medicare looks at weight loss as a lifestyle concern, and therefore, weight loss drugs and weight loss in general are not considered medical necessities in most cases.

Exceptions to the rule

Although Medicare benefits do not cover weight loss drugs outright, there are some exceptions to the program’s rules. For example, some popular diabetes drugs are prescribed for off-label usage as weight loss medications.

If you have been prescribed one of these medications to treat a medical condition like diabetes and you experience weight loss as a side effect, Medicare will still cover the medication as long as you have prescription drug coverage through Medicare Part D. The medication must also be included in your plan’s formulary to be considered for coverage.

Medicare benefits may pay for bariatric surgery in the event that your doctor feels that this surgery is medically necessary to preserve your health. If weight loss surgery is covered by Medicare, Part B will supply benefits. Medicare Part B is outpatient insurance and covers things like surgical procedures, diagnostic testing and durable medical equipment.

Does Medicare cover over-the-counter weight loss drugs?

Although you may be able to receive Medicare coverage for some medications that promote weight loss when they are prescribed for off-label usage, Original Medicare does not cover over-the-counter medications. This restriction doesn’t just apply to weight loss drugs and supplements either. Medicare does not cover any over-the-counter medications or supplements, even if you carry Part D prescription drug coverage.

Medicare Advantage plans may cover additional benefits

Despite the fact that Original Medicare benefits do not cover weight loss medications outright, you may still be able to obtain coverage for weight loss assistance through a Medicare Advantage plan. These are Medicare plans offered by private insurance providers.

A Medicare Advantage plan includes the same benefits as Original Medicare, but providers have the option to include extras not found in Original Medicare plans. Some Medicare Advantage plans include an over-the-counter allowance and/or access to a fitness program designed especially for seniors. SilverSneakers, for instance, is a fitness program for seniors who want to be active, gain strength, or simply enjoy the social aspects of a fitness class, but you should always consult with your physician before starting, changing or stopping a diet or exercise routine.