This New Medicare Option Could Be a Game Changer for Seniors

You probably saw some living expenses drop once you retired. You likely spend less on work clothes, gas for commuting, child care, and, of course, saving for retirement. But other expenses may have risen sharply to take their place, including healthcare.

Medical expenses tend to increase as you age, regardless of how healthy you are. If you struggle with obesity, that can lead to further costly complications. But a recent Medicare change could help keep your retirement healthcare costs a bit more manageable going forward.

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Medicare beneficiaries can now get GLP-1s for weight loss for $50 per month

Medicare beneficiaries have long had their GLP-1s covered for conditions like type 2 diabetes, but the program only began covering the drugs for weight loss on July 1. This is part of a new Medicare GLP-1 Bridge program that runs through Dec. 31, 2027.

Those who qualify will have a $50 copay on the following GLP-1s only:

• Foundayo (tablet)
• Wegovy (injection or tablet)
• Zepbound (KwikPen only)

But not every Medicare beneficiary will qualify for this offer. You have to meet the following criteria:

1. You must have a Medicare Part D plan or a Medicare health plan that includes drug coverage.
2. You're not currently eligible to receive GLP-1s through your existing Medicare drug plan.
3. You don't have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease (your Medicare drug plan may cover GLP-1s for these conditions).
4. You're at least 18 years of age and meet one of the following criteria:
1. You have a body mass index (BMI) of 35 or higher.
2. Your BMI is 30 or higher, and you have certain types of heart failure, high blood pressure that's hard to control, or chronic kidney disease (stage 3a or above).
3. Your BMI is 27 or higher, and you have prediabetes, or you've had a heart attack, stroke, or blocked arteries in your legs or arms.

Your doctor can help you determine your BMI if you're not sure. You'll need to get a prescription from them, too.

What if you don't qualify for the $50 copay?

If Medicare's GLP-1 Bridge program isn't right for you, you can check any supplementary health insurance policies you have to see if these cover GLP-1s for weight loss. It doesn't hurt to reach out to the drug providers, too, to see if they have discounts for seniors or low-income families. You may also be able to find coupons online.

It's not clear what will happen to Medicare's GLP-1 coverage after the GLP-1 Bridge program ends. But it's possible that your Medicare plan will cover these drugs in the future, even if it doesn't today.

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