If you are on Medicare and have wanted to try Wegovy or Zepbound, you have probably heard that Medicare now covers these medications for $50 a month. That is true, but only for people who meet a specific set of rules, and the most important one trips up a lot of Long Island seniors. The Medicare GLP-1 Bridge requires you to have Medicare Part D prescription coverage. At Long Island Weight Loss Institute (LIWLI), it is one of the most common questions our patients ask, so here is what you need to know before you assume you are covered.
What Is the Medicare GLP-1 Bridge?
The Medicare GLP-1 Bridge is a temporary federal program that lets eligible people with Medicare drug coverage get certain GLP-1 weight loss medications for a $50 copay per one-month supply. According to Medicare.gov, coverage started on July 1, 2026, and approvals under the program are valid through December 31, 2027.
The program covers three FDA-approved weight loss medications:
- Wegovy (semaglutide), in both the weekly injection and the daily tablet
- Zepbound (tirzepatide), in the KwikPen version only
- Foundayo (orforglipron), a daily tablet
Each of these medications is FDA-approved for chronic weight management in adults who meet BMI criteria. Before the Bridge, Medicare drug plans could not cover these medications when they were used only for weight loss, which left many seniors paying out of pocket or going without.
The $50 copay does not count toward your Part D deductible or yearly out-of-pocket limit, and Extra Help, the Medicare program for people with limited income, cannot reduce it.
Do You Need Medicare Part D to Qualify for the GLP-1 Bridge?
Yes. You must be enrolled in Medicare drug coverage, also called Part D, to use the Bridge. Having Medicare alone is not enough, and having some other kind of prescription insurance does not count.
Medicare.gov lists the types of coverage that qualify:
- A standalone Medicare Part D prescription drug plan added to Original Medicare
- A Medicare Advantage plan that includes drug coverage
- A Medicare Special Needs Plan
- An employer or union group plan that provides your coverage through Medicare Part D
- The Limited Income Newly Eligible Transition (LI NET) program
If your prescriptions are covered some other way, you do not qualify for the $50 copay, even if you meet every medical requirement. This is the detail most people miss.
Why Some Long Island Seniors Miss Out on the Bridge
Many Long Island seniors chose a different type of prescription coverage when they first signed up for Medicare, and that choice now keeps them out of the Bridge. LIWLI providers regularly meet patients who are medically eligible but cannot use the program because they do not have a Part D plan.
Here are the situations to watch for:
- You have Original Medicare plus a Medigap supplement.Medigap helps with hospital and doctor costs, but current Medigap policies do not include drug coverage. Unless you also added a Part D plan, you are not eligible.
- You get prescriptions through a retiree plan.Some employer and union retiree plans deliver drug coverage through Medicare Part D, and some do not. Only the Part D kind counts.
- Your prescriptions come only from the VA or TRICARE.These benefits do not meet the Part D requirement on their own.
- You have a Medicare Advantage plan without drug coverage.The plan must include Part D benefits.
The good news is that timing is on your side. Medicare Open Enrollment runs from October 15 to December 7, and changes you make during that window take effect for 2027. If you do not have Part D today, this is the time to look at your options.
One caution before you switch anything: if you have retiree health coverage from a former employer or union, call your benefits administrator first. In some cases, changing your drug coverage can affect your retiree health benefits or your spouse’s coverage. You can also get free, unbiased help by calling 1-800-MEDICARE (1-800-633-4227).
Free Medicare Help in Nassau and Suffolk Counties
If you are not sure what kind of drug coverage you have, you do not have to sort it out alone. Two New York State programs are especially useful for Long Island seniors.
- HIICAP.The Health Insurance Information Counseling and Assistance Program offers free, objective Medicare counseling through local offices for the aging. Call 1-800-701-0501 and you will be connected to the program for Nassau or Suffolk County. A counselor can help you check whether your coverage includes Part D and walk through your plan options.
- EPIC.New York’s Elderly Pharmaceutical Insurance Coverage program helps eligible seniors with prescription costs. EPIC members must be enrolled in Part D, and joining EPIC opens a Special Enrollment Period to join a Part D plan at any time of year. That can help if you miss the December 7 deadline. EPIC has its own eligibility rules, so call the EPIC helpline at 1-800-332-3742 to see if you qualify.
One thing EPIC cannot do is lower the Bridge copay. CMS guidance for pharmacies says the Bridge does not coordinate with other coverage, and the $50 copay is the patient’s responsibility.
Who Qualifies for the Medicare GLP-1 Bridge?
Once you have Part D, you also need to meet medical criteria based on your body mass index (BMI) when you start GLP-1 therapy. According to Medicare.gov, you must be at least 18 and meet one of these:
- A BMI of 35 or higher
- A BMI of 30 or higher plus diastolic heart failure, uncontrolled high blood pressure, or stage 3a or higher chronic kidney disease
- A BMI of 27 or higher plus prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms
There are also important exclusions. You are not eligible for the Bridge if your Part D plan already covers a GLP-1 for you, or if you have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease. That does not mean you cannot get a GLP-1. It means your regular Part D plan may cover it for that condition instead, with its own rules and costs.
If you started a GLP-1 before joining the Bridge, your eligibility is based on your BMI when you began treatment, not your weight today. Your provider documents that starting point for you.
How to Get Started With the GLP-1 Bridge on Long Island
The process starts with a provider who can confirm your eligibility and handle the paperwork. Here is how it typically works:
- Confirm your coverage. Check that you have a Medicare Part D plan or a Medicare Advantage plan with drug coverage.
- Meet with a provider. Your provider reviews your BMI, health history, and current medications to see whether you meet the criteria and whether a GLP-1 is appropriate for you.
- Prescription and prior authorization. Your provider sends the prescription to your pharmacy and completes a prior authorization when requested, certifying that the medication is part of a diet and exercise program.
- Pick up your medication. Your pharmacy may ask for your Medicare Number, and you will get a letter confirming coverage under the Bridge.
The Bridge requires the medication to be part of a lifestyle program with structured nutrition and physical activity. At LIWLI, that support is built into every treatment plan through our weight loss injection program, along with regular monitoring of your progress, side effects, and lab work.
Check Your Part D Coverage Before Open Enrollment Ends
The Medicare GLP-1 Bridge is a real opportunity for Long Island seniors who have struggled to afford weight loss medication. But you have to have Medicare Part D drug coverage to use it, and Open Enrollment closes on December 7. If you are not sure what kind of coverage you have, now is the time to find out.
Long Island Weight Loss Institute can review your eligibility, explain your medication options, and handle the prior authorization process. We offer consultations at our offices in East Meadow, Amityville, Smithtown, and Port Jefferson Station, as well as telehealth visits. Request a consultation to find out whether the Medicare GLP-1 Bridge is right for you.