Medicare Will Now Cover Wegovy for Heart Disease Patients — Here’s What the New Policy Actually Means

Medicare has changed its stance on GLP-1 drugs like Wegovy, moving into 2026. While it is known for its weight loss effects, Medicare Part D plans will finally be able to cover the drug under a new medical indication. Because the Food and Drug Administration (FDA) has officially approved Wegovy for reducing the risk of heart attack and stroke in people with cardiovascular disease, it is now covered by Medicare.

This shift opens the door for many seniors who were previously blocked by federal law from accessing the medication when it was prescribed solely for obesity. But coverage is not automatic, and the rules are more complicated than many headlines suggest. Here is what the new policy actually means for you.

Medicare Can Cover Wegovy Only for Heart Disease, Not Weight Loss

The most important change is that Medicare Part D may now cover Wegovy only when it is prescribed for cardiovascular risk reduction in patients with established heart disease who are overweight or obese. This is because the FDA approved Wegovy in 2024 for reducing the risk of heart attack and stroke in this specific population, which removes it from Medicare’s statutory exclusion on weight‑loss drugs.

Medicare is still prohibited by law from covering Wegovy when used solely for obesity, even if a patient meets BMI criteria. That means the diagnosis code and medical documentation must clearly reflect cardiovascular disease (not weight management) as the treatment purpose. Seniors should expect their prescribers to justify the medication based on the new FDA‑approved indication.

Part D Plans Decide Whether and How They Cover Wegovy

Even though Medicare can now cover Wegovy for heart disease, individual Part D plans still control their formularies. Plans may choose to include Wegovy, restrict it with prior authorization, or place it on a higher cost‑sharing tier. Because Wegovy is expensive, many plans are expected to require documentation proving cardiovascular disease and medical necessity.

Some plans may also require patients to try alternative therapies first, depending on their internal policies. Seniors should review their plan’s 2026 formulary or call their insurer to confirm whether Wegovy is included and what the copay structure looks like.

Out‑of‑Pocket Costs Will Vary Widely Under Part D Rules

Even with coverage, Wegovy will not be cheap for most Medicare beneficiaries. Part D plans can apply deductibles, coinsurance, and specialty‑tier pricing to high‑cost medications like GLP‑1s. Because Wegovy is typically categorized as a specialty drug, many seniors will face percentage‑based cost‑sharing rather than flat copays.

Costs may also shift throughout the year as patients move through the deductible, initial coverage phase, and catastrophic coverage phase. Beneficiaries should compare plans during open enrollment to avoid paying more than necessary.

New Coverage Pathway Applies Only to Patients With Documented Heart Disease

The FDA’s expanded indication applies specifically to people who are overweight or obese and have established cardiovascular disease. This includes patients with a history of heart attack, stroke, or other qualifying conditions. Medicare coverage follows this same rule: no documented heart disease means no coverage. This distinction is critical because many patients who want Wegovy for weight loss alone will still be denied under federal law. Seniors should expect their doctors to provide detailed medical records to support the cardiovascular diagnosis.

The Policy Change Could Expand Access for Millions of Seniors

Because heart disease is the leading cause of death among older adults, the new FDA indication dramatically expands the number of Medicare beneficiaries who may qualify for Wegovy. KFF notes that the updated approval “opens the door to Medicare coverage for millions of people with obesity” who also have cardiovascular disease.

This marks one of the biggest shifts in Medicare drug coverage in years, especially for GLP‑1 medications. While not every senior will qualify, the number of eligible patients is expected to grow as more cardiologists incorporate GLP‑1 therapy into treatment plans.

Medicare’s Weight‑Loss Drug Exclusion Still Remains in Place

Despite the headlines, Medicare has not changed its long‑standing prohibition on covering weight‑loss medications. The only reason Wegovy can now be covered is that the FDA granted a new medical indication unrelated to weight loss.

This means Medicare still cannot cover Wegovy (or any GLP‑1) when prescribed solely for obesity. Patients should be cautious about assuming coverage applies broadly; the law remains unchanged, and only the cardiovascular indication qualifies. This distinction will continue to shape coverage decisions in 2026 and beyond.

What This Means for Seniors Navigating Coverage in 2026

Medicare’s new ability to cover Wegovy for heart disease patients is a major shift, but it comes with strict rules and significant cost considerations. Seniors who qualify under the cardiovascular indication may finally gain access to a medication that reduces their risk of heart attack and stroke. But coverage is not guaranteed, and out‑of‑pocket costs may still be high depending on the Part D plan. Reviewing plan formularies, confirming medical documentation, and comparing coverage options during open enrollment will be essential steps for anyone considering Wegovy in 2026 and beyond.

Do you think Medicare should expand coverage of GLP‑1 drugs beyond heart disease? Share your thoughts in the comments.

What to Read Next

3 Million Seniors Face Medicare Advantage Disruptions as Insurers Exit Markets for 2026

Why Medicare Is Denying More Diabetic Shoe Claims — And the Documentation Doctors Must Provide

Medicare’s Appeal System is Backfiring — And Seniors Are Getting Bigger Bills

The Routine Home Visit That’s Triggering Surprise Medicare Denials

March 31 Medicare Warning: Last Chance to Fix a Bad Advantage Plan Before Summer

Drew Blankenship

Drew Blankenship is a seasoned automotive professional with over 20 years of hands-on experience as a Porsche technician.  While Drew mostly writes about automotives, he also channels his knowledge into writing about money, technology and relationships. Based in North Carolina, Drew still fuels his passion for motorsport by following Formula 1 and spending weekends under the hood when he can. He lives with his wife and two children, who occasionally remind him to take a break from rebuilding engines.