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Who qualifies for the Medicare GLP-1 Bridge?

Short answer: you need Medicare drug coverage plus one of three BMI-based tiers — BMI 35+, BMI 30+ with certain conditions, or BMI 27+ with certain other conditions. And if you have type 2 diabetes, moderate-to-severe sleep apnea, or MASH, you follow a different coverage path entirely.

Last verified against CMS: July 21, 2026

Eligibility flowchart: Medicare drug coverage, then routing conditions, then BMI tiers determine whether you likely qualify for the $50 GLP-1 Bridge program.1. Do you have Medicare drugcoverage? (Part D or MedicareAdvantage with drug coverage)NoEnroll first: Open Enrollmentis Oct 15 – Dec 7.Then come back to this chart.Yes2. Diagnosed with type 2 diabetes,moderate-to-severe sleep apnea,or MASH (fatty liver w/ scarring)?YesDifferent path: standard Part Dcovers your GLP-1 — often onbetter terms. (Not the Bridge.)No3. What is your BMI?BMI 35 or higher✓ Likely eligible — Tier 1BMI 30–34.9 + one of:kidney disease (stage 3a+),heart failure, or blood pressurenot controlled by medication✓ Likely eligible — Tier 2BMI 27–29.9 + one of:prediabetes, a prior heart attackor stroke, or leg-artery diseasewith symptoms (PAD)✓ Likely eligible — Tier 3BMI below 27, or no qualifyingcondition at your BMI levelBridge unlikely — see ouralternatives guides
The whole program in one chart. Your provider’s prior authorization makes the official call — this shows what they’ll check.

First requirement: Medicare drug coverage

You must be enrolled in Medicare drug coverage — a standalone Part D plan or a Medicare Advantage plan with drug coverage (MA-PD). The Bridge works alongside any such plan; no plan switch is needed.

The three eligibility tiers

Tier 1: BMI 35+

No additional conditions required.

Tier 2: BMI 30+

Plus at least one of: chronic kidney disease (stage 3a or higher), heart failure, or high blood pressure that medication hasn’t controlled.

Tier 3: BMI 27+

Plus at least one of: prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease.

The three conditions that route you elsewhere

These do not mean “no coverage” — they mean Medicare already covers GLP-1s for your condition under standard Part D, which has different (often better) cost rules: Extra Help applies and payments count toward the annual out-of-pocket cap.

How eligibility is actually decided

Not by you, and not by this site: your prescriber submits a prior authorization to the program’s central processor (administered by Humana) documenting your BMI and any qualifying condition. Our checker mirrors the published criteria so you know what to expect before the appointment.

Take the 2-minute eligibility check →

Deep dives: every tier, condition, and threshold

By tier

By BMI

By qualifying condition

Routed to a different path

Ready to move? How to apply, step by step.

Sources: CMS — Medicare GLP-1 Bridge · KFF · AARP