BMI 27: which tier am I in?
Published by GLP-1 Coverage Guide · Updated · No clinician review is credited for this page.
Short answer: A BMI of 27 to 29.9 puts you in reach of the Medicare GLP-1 Bridge's Tier 3: you qualify if you also have prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms. BMI 27 is about 167 pounds at 5'6", 178 at 5'8", or 188 at 5'10".
Sources for the coverage rules are listed below. An update date marks a revision; it does not imply a sitewide medical review.
Use BMI when GLP-1 therapy started
CMS uses BMI at the initiation of GLP-1 therapy, including treatment that began before Medicare enrollment or July 1, 2026. If you have already lost weight on treatment, ask your prescriber to document the starting criteria from your medical records. A lower BMI today does not replace the starting BMI.
This calculator gives an estimate, not a coverage decision. It rounds the estimate to one decimal, to match the one-decimal BMI ranges on the CMS prior-authorization form (27 to 29.9, 30 to 34.9, 35 to 39.9), and uses that same number for the thresholds; your prescriber must attest to the documented criteria.
What BMI 27 looks like
BMI 27 sits in the 'overweight' range — not obesity. Examples: 5'4" at 157 lbs, 5'6" at 167 lbs, 5'8" at 178 lbs, 5'10" at 188 lbs, 6'0" at 199 lbs. Many people at these weights assume prescription weight-loss coverage isn't aimed at them; at this program's Tier 3, it is — provided one qualifying condition is present.
Prediabetes is one of the published qualifying conditions. Ask your clinician whether a documented diagnosis applies to you.
BMI at the start of GLP-1 therapy
Already taking a GLP-1? Use your height and weight when therapy first started. CMS accepts qualifying starting criteria from before Medicare enrollment or July 2026. If starting therapy now, use pre-treatment measurements. Ask your prescriber for records if you do not know.
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Common questions
Can I qualify at BMI 27 with no health conditions?
No — at BMI 27–29.9 one Tier 3 condition is required: prediabetes, prior heart attack, prior stroke, or symptomatic PAD. BMI alone qualifies only at 35+.
What if my BMI is 26.8?
The threshold is 27, and the measurement that counts is the documented BMI when GLP-1 therapy began. 26.8 falls in the CMS form's "less than 27" range, so do not round it up to 27; ask your prescriber to check the starting records.
Related
Criteria source: CMS provider guidance: BMI at therapy initiation · CMS prior authorization form