September 24th 2024
By Ari Parker
Learn about Medicare Zepbound coverage and how Zepbound compares to other drugs, like Mounjaro, Ozempic, and Wegovy. Plus, get weight loss support from Medicare.
Zepbound, Ozempic, Wegovy, and Mounjaro grew in popularity when many people realized they could get an Ozempic prescription to aid with weight loss. While these drugs are all approved by the FDA, not all of them are approved specifically for weight loss. Furthermore, Medicare doesn’t cover each of these prescriptions. In fact, both Original Medicare and Medicare Part D don’t cover drugs prescribed solely for weight loss.
In this guide, we’ll explore all the details you need to know about Zepbound, including what it is, if it’s covered by Medicare, and how it compares to other popular weight loss medications.
Zepbound belongs to the same category of drugs as Ozempic, Wegovy, and Mounjaro.
Zepbound is currently only approved for weight loss management in adults.
Zepbound is not covered by Medicare Part B or Medicare Part D.
Medicare covers several preventive care services that can help you manage your weight.
Zepbound is one of a handful of prescriptions that are being used to aid with weight loss. Some of the other popular prescriptions in this category include Mounjaro, Ozempic, and Wegovy. These prescriptions are scientifically known as incretin mimetics, which mimic gut hormones called incretins to help regulate digestion, blood glucose levels, and appetite.
Other prescriptions in the same category may be approved or used to help treat Type 2 diabetes or cardiovascular issues. Zepbound is currently only approved to aid with weight management in adults.
Zepbound is not covered by Medicare—Part D or Part B. Generally speaking, Medicare does not cover prescriptions for weight loss. There are ongoing conversations, however, about Medicare covering weight loss medications to treat and reduce obesity.
As we shared above, Zepbound belongs to a group of drugs called incretin mimetics. These drugs mimic the effects of incretins, which are gut hormones that help regulate digestion, blood glucose levels, and appetite. By mimicking incretins, these drugs have the potential to help support weight loss and treat Type 2 diabetes, sleep apnea, and chronic kidney disease.
Incretin mimetics include Zepboung Wegovy, Ozempic, and Mounjaro—each of which are similar but have key differences. We explore those differences below.
Both Zepbound and Wegovy are injected once a week and can be effective medications for weight management. Zepbound may result in greater weight loss than Wegovy.
Zepbound is a tirzepatide, approved for weight management in adults. Wegovy is more like Ozempic, and is a semaglutide. That said, while Ozempic is primarily used to treat Type 2 diabetes, Wegovy is primarily used to aid with weight loss.
You learned above that Medicare will not cover Zepbound. Medicare does not cover Wegovy to support weight loss. However, Medicare will cover Wegovy if you need it to reduce your risk of heart attack and stroke. Learn more about Medicare Wegovy coverage.
Both Zepbound and Ozempic have features that can promote weight loss in adults. That said, Zepbound is a tirzepatide that’s approved to support weight loss in adults who meet the right BMI criteria. Ozempic is a semaglutide that’s approved to treat Type 2 diabetes. Ozempic can also lower the risk of cardiovascular problems for people who have Type 2 diabetes or heart disease.
Both Zepbound and Ozempic are injectable prescription drugs. Zepbound pens typically come with one dose, while Ozempic pens hold multiple doses.
Medicare Part D covers Ozempic to treat diabetes. Medicare Part D will not cover Ozempic for weight loss, in part because the drug isn’t approved to support weight loss. Medicare Part D will not cover Zepbound. Because Ozempic is used by many for weight loss rather than to treat Type 2 diabetes, it’s common for insurance companies to require prior authorization for the prescription.
Both Zepbound and Mounjaro are brand names for tirzepatide, an incretin mimetic. While they’re the same drug, Mounjaro and Zepbound are approved for different uses. Like Ozempic, Mounjaro is used to treat Type 2 diabetes. Zepbound, like Wegovy, is used to aid in weight loss for people with certain BMIs.
Because Zepbound and Mounjaro have different approved uses, they’re covered differently by insurance plans. As we covered before, Zepbound is not covered by Medicare. Medicare Part D can cover Mounjaro to treat Type 2 diabetes.
Losing weight after 60 can be challenging. As we age, our metabolisms slow down, hormones change, and health conditions can make getting exercise more difficult. While Medicare does not cover drugs prescribed for weight loss, it does cover some services that can help you with weight management.
To start, during your Annual Wellness Visit, your doctor can provide personalized health advice and help you create a screening schedule for preventive services. The Wellness Visit, alongside other preventive care services covered by Medicare, can help you maintain your health, catch health issues early, and develop a plan for weight loss or management.
Medicare covers nutrition counseling if you have diabetes, chronic kidney disease, or have had a kidney transplant in the past 36 months. Medicare also covers weight loss counseling for those with a BMI of 30 or more.
In rare cases, if you meet the strict eligibility criteria, Medicare may cover weight loss surgery.
If you want help managing your weight and are unsure about what Medicare covers, talking to your doctor during your Annual Wellness Visit is a great place to start!
