Medicare does not currently cover weight loss medications, but it may cover Mounjaro for type 2 diabetes. Coverage may depend on your prescription drug plan type, and out-of-pocket costs may apply.
If you have type 2 diabetes, you have a greater amount than usual of sugar in your blood, also called blood glucose. This happens because the insulin in your body doesn’t work well.
Type 2 diabetes is a common, chronic condition that some people may be able to manage by making adjustments to their diet and ensuring they get regular exercise.
This may not work for everyone, though. In this case, a doctor or healthcare professional may prescribe medications like Mounjaro to help manage the condition.
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If you have a Medicare Part D prescription drug plan or a Medicare Advantage (Part C) plan that includes prescription drug coverage, it may cover Mounjaro.
Medicare drug plans have drug lists, known as formularies. You can check your formulary to confirm whether Mounjaro is included, though it may not be a preferred drug. To ensure you aren’t left with unexpected out-of-pocket costs, consider speaking to your insurer and getting prior approval.
Prescription drug plans may still have some out-of-pocket costs, but from 2025 on, you will pay no more than $2,000 per calendar year. You will also have the option of spreading out the costs of your medications with a payment plan.
Help with costs
If you need help paying for prescription medications, the Extra Help program is available. It can help cover the costs of plan premiums, deductibles, and coinsurance.
To be eligible for Extra Help, you must have income and resources below specific amounts. In 2025, these amounts are:
| Single person income | $22,590 |
|---|---|
| Income of a married couple living together | $30,660 |
| Single person resources | $17,600 |
| Resources of a married couple living together | $35,130 |
Some items do not count toward resource limits, such as your primary residence, vehicle, and personal possessions.
Applying for Extra Help
You can apply for Extra Help online or by calling Social Security at 800-772-1213 (TTY: 800-325-0778) to apply over the phone or request an application form. You can also apply at your local Social Security office.
Mounjaro is a brand-name medication containing the active ingredient tirzepatide, which makes the drug work. Currently, there is no generic version of Mounjaro available.
The drug helps your body release more insulin — the hormone that decreases your blood sugar levels. It also slows sugar production in your liver and slows the emptying of food from your stomach. These combined effects can help manage type 2 diabetes.
The FDA has not approved Mounjaro for weight loss, but some healthcare professionals may prescribe it for weight loss off-label.
Mounjaro is a liquid that you inject under your skin using a prefilled pen. You usually do this once per week.
To learn more, read this Mounjaro article.
While Medicare doesn’t currently cover Mounjaro for weight loss, it may cover it in the future.
Medicare is reviewing its current policy regarding antiobesity medication exclusions, and this could mean that weight loss medications will become available through Medicare in 2026.
Mounjaro may be covered under Medicare Part D or through a Medicare Advantage (Part C) plan that includes coverage of prescription drugs, as long as a doctor prescribes it to you to manage type 2 diabetes.
Mounjaro is not currently available through Medicare for weight loss, but this may change in the future following a Medicare review of currently excluded antiobesity medications.