There are two covered paths to treating obesity — medication and surgery — and each has its own gates. This is the complete map of how the major insurers decide, with links to the exact rules for your plan.
GLP-1 and GIP/GLP-1 medications — Wegovy (semaglutide) and Zepbound (tirzepatide) — are the most-requested and most-denied drugs in the country. Coverage runs through three gates:
The full breakdown, insurer by insurer, is here: GLP-1 coverage by insurer → And the fastest way to settle the first gate is to look up your exact drug on your plan's formulary with our Drug Lookup.
Surgery is covered more consistently than drugs — but the BMI threshold differs sharply by insurer, which is exactly where people get tripped up. Cigna has adopted the newer, lower thresholds; most others still use the traditional bar; Medicare always requires a comorbidity.
| Insurer | BMI alone | BMI with a condition | Notable requirement |
|---|---|---|---|
| Cigna | ≥35 | ≥30 | Lowest bar; no fixed multi-month diet |
| Aetna | ≥40 | ≥35 | Evaluations + a supervised program |
| UnitedHealthcare | ≥40 | ≥35 | Often a designated facility + program |
| Anthem / Elevance | ≥40 | ≥35 | Documented conservative therapy |
| Medicare | — | ≥35 + a condition + failed medical treatment | No BMI-alone path |
Read the exact rules, covered procedures, and what to document for your insurer:
The lower BMI bar — 35, or 30 with a condition.
BMI 40/35, evaluations + supervised program (CPB 0157).
BMI 40/35, plus a designated facility on many plans.
BMI 40/35 + documented conservative therapy (CG-SURG-83).
Covers surgery (unlike drugs) — BMI 35 + a condition (NCD 100.1).
Answer a few questions and see where you stand in two minutes.
Even when the weight-loss benefit is excluded, the same molecules are often covered under a different FDA-approved indication: Zepbound for obstructive sleep apnea, Wegovy for cardiovascular risk reduction in people with heart disease, or the same semaglutide/tirzepatide as Ozempic / Mounjaro for type 2 diabetes. Matching the drug to the indication your plan does cover is often the whole game.
Not for weight loss — but yes for heart-disease risk.
Why the exact form and strength can decide coverage.
Pick your drug or procedure, your insurer, and your situation, and see exactly where you stand — free, anonymous, no signup.
Check my weight-loss coverageOften surgery, surprisingly. Bariatric surgery is covered fairly consistently when you meet the BMI and comorbidity criteria. Weight-loss drugs hit an earlier gate — whether your plan buys an anti-obesity drug benefit at all — which many employer plans and all of Medicare Part D do not for the weight-loss indication.
It depends on the insurer. Cigna covers surgery at a BMI of 35 alone (or 30 with a weight-related condition); Aetna, UnitedHealthcare and Anthem generally require 40, or 35 with a condition; Medicare requires 35 or higher plus a comorbidity and failed prior medical treatment.
Yes — that contrast is real. Federal law bars Medicare Part D from covering drugs used for weight loss, so Wegovy and Zepbound aren't covered for obesity. But bariatric surgery is covered under Medicare Part A/B when you meet the NCD 100.1 criteria.
Most often because your plan doesn't cover weight-loss drugs at all, or you didn't have a documented supervised weight-management program before the drug, or you were below the BMI threshold. The supervised-program gap is the most common fixable reason.
Explore: coverage checker · Drug Lookup · all guides · all tools