Tool · Updated March 2026

Insurance Readiness Checker

Will your insurance cover GLP-1 medication? Answer 5 questions about your health profile and insurance type. I will estimate your coverage likelihood and tell you exactly what to do next.

What is your BMI range?

Most insurers require a minimum BMI for GLP-1 coverage. If you do not know your BMI, use a BMI calculator with your height and weight.

How This Tool Works

This checker evaluates five factors that insurers typically consider when approving GLP-1 medication coverage: your BMI, existing health conditions, the specific medication, your insurance type, and whether you have a doctor recommendation. The weights are rules of thumb I set by hand, not a model built on approval data. Use the result as a checklist of what to have ready before you call your insurer, not as a prediction of approval.

Important: This is an estimate, not a coverage guarantee. Every insurance plan has its own formulary, prior authorization requirements, and coverage criteria. The only way to know for certain is to check with your insurer or submit a prior authorization through your doctor.

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Frequently Asked Questions

What BMI do I need for insurance to cover GLP-1 medication?

Most insurers follow FDA labeling criteria: BMI of 30 or higher, or BMI of 27 or higher with at least one weight-related comorbidity (type 2 diabetes, hypertension, high cholesterol, or sleep apnea). Some employer plans have stricter cutoffs, so check your specific plan documents.

Does Medicare cover Ozempic, Wegovy, or Mounjaro?

Medicare Part D coverage for GLP-1 medications has expanded since 2025. Ozempic and Mounjaro are more commonly covered under their diabetes indications. Wegovy and Zepbound (prescribed specifically for weight loss) have more limited Medicare coverage that varies by plan. Contact your Part D plan directly for formulary details.

What is prior authorization and how long does it take?

Prior authorization is when your doctor submits paperwork to your insurer proving that GLP-1 medication is medically necessary for you. The process typically takes 5 to 15 business days. Your doctor will need to include your BMI, documented comorbidities, and often evidence of past diet or exercise attempts. If denied, you can appeal with additional documentation.