“Medicare covers GLP-1s for weight loss” reads like a benefit for everyone on the program who’s carrying extra weight (most people!). But if you run the numbers, the real coverage number is about about 3.8 million beneficiaries. That’s roughly 7% of Medicare.

Of the 13 million Medicare beneficiaries with overweight or obesity, most get filtered because they already qualify for a GLP-1 some other way. This post walks through the eligibility funnel step by step, explains why the excluded group is larger than the eligible one, and shows what the final 3.8 million costs Medicare.

How many Medicare beneficiaries qualify for the GLP-1 Bridge?

If you start with everyone on Medicare who has excess weight, and narrow down from there, here’s what it looks like:

The Bridge eligibility funnel. The single largest cut is the 5.9 million who already have a path to a GLP-1 through a Part D plan, and so don’t need the Bridge.

The clinical criteria in the second row are the BMI thresholds from the Bridge rules: a BMI of 35 alone, a BMI of 30+ with heart failure, uncontrolled hypertension, or kidney disease, or a BMI of 27+ with pre-diabetes, a prior heart attack, a prior stroke, or peripheral artery disease.

Why the eligible population is smaller than it looks

The 5.9 million excluded people mostly have a diagnosis that unlocks a GLP-1 on its own. Type 2 diabetes covers Ozempic, Mounjaro, and Rybelsus. Moderate-to-severe sleep apnea covers Zepbound. MASH with liver fibrosis covers Wegovy. Each of these is a Part D pathway that predates the Bridge, so CMS carves those people out to keep the demonstration from paying for prescriptions Part D would cover anyway.

This post is part of our series on Medicare coverage for cardiovascular health. For the full rules on eligibility, cost, and enrollment, see Medicare covers GLP-1s for $50/month.