How Much Does Ozempic Cost with Medicare? Coverage and Pricing Guide

Ozempic (semaglutide) is a medication commonly used for type 2 diabetes and sometimes for weight loss. However, it’s expensive, around $968-$1,000 per month without insurance, so Medicare coverage is important.

Medicare Part D plans usually cover Ozempic for diabetes, with most people spending $0-$100 a month. This is because of a $2,000 out-of-pocket limit set by the Inflation Reduction Act. Medicare Advantage (Part C) plans might cover it too, sometimes with $0 copays.

However, if you’re using Ozempic just for weight loss, coverage is usually not included, meaning you’d likely have to pay the full cost out of pocket.

In today’s article, we’ll look at costs, coverage, and ways to save money. We’ll use official Medicare information to explain everything simply.

How Much Does Ozempic Cost with Medicare

Medicare Coverage for Ozempic: Part D vs. Advantage Plans

Medicare Part D and Medicare Advantage plans cover Ozempic in different ways, but both follow Medicare rules. Original Medicare doesn’t cover prescriptions like Ozempic. To get it, you need a Part D plan or a Medicare Advantage plan with drug coverage.

For type 2 diabetes, Ozempic is covered as a preferred or non-preferred brand (usually Tier 3 or specialty Tier 4/5) in most 2025 formularies. This means it’s on the plan’s drug list with set copays or coinsurance. Medicare Advantage plans from companies like Humana, Aetna, or UnitedHealthcare often include this coverage, sometimes with lower costs or extras like mail-order discounts.

Medicare usually does not cover drugs for just weight loss. So, if you use Ozempic for this reason, you will likely pay the full price. Some special plans might offer help, but this is not common.

Medicare Part D Changes Impacting Ozempic Costs

The Inflation Reduction Act made big changes to Part D in 2025. It got rid of the “donut hole” (a gap in coverage) and set a limit of $2,000 a year for out-of-pocket costs on covered drugs (including deductibles and copays).

Before, after spending about $4,660, people had to pay 25% until they hit catastrophic coverage. Now, once you spend $2,000, your copays drop to $0 for the rest of the year.

Deductibles are capped at $590 (some plans $0), and average Part D premiums are about $47/month. For expensive drugs like Ozempic, this cap makes it much cheaper most users pay less than $500/year out of pocket for diabetes use. Extra Help can lower costs to $0 for those who qualify.

Breakdown of Ozempic Costs with Medicare in 2025

Costs vary by plan tier, phase, and income:

Deductible Phase: You pay the full price (about $800-900) until you spend up to $590.
Initial Coverage: You pay $30-100 per month or 25%, depending on the medication.
After $2,000 Out-of-Pocket Limit: You pay $0 for the rest of the year.
Medicare Advantage: Usually lower costs ($0-50) or a set price for special medicines.

For weight loss (non-covered): Full price $968/month, no cap benefit.

Prior Authorization and Eligibility Requirements

Prior authorization (PA) is required for Ozempic under nearly all Medicare plans to verify a type 2 diabetes diagnosis and demonstrate unsuccessful trials of more affordable alternatives like metformin.

The necessary documentation usually includes A1C levels, BMI (in some cases), and physician notes. While approval is commonly granted for diabetes management, requests for weight loss purposes alone are often denied.

User Experiences and Reports

Medicare users on platforms like Reddit and Facebook are sharing their experiences with diabetes coverage in 2025. Many report paying between $25 and $95 per month and are happy about the $2,000 annual cap on out-of-pocket costs. For example, one user said, “I hit the cap by March with Ozempic, and the rest of the year was free!”

But those who want Ozempic just for weight loss are upset. Medicare won’t pay for it, so they have to pay around $900 a month themselves.

On the other hand, some Advantage plan members have noted $0 copays for diabetes medications with providers like Humana or Aetna.

One common issue is delays in prior authorization, which can take 1 to 4 weeks. However, users report that about 50% of appeals are successful when they include strong documentation from doctors.

Alternatives and Savings Options If Costs Are High

If Ozempic is too expensive or not covered, other options like Trulicity or Jardiance might be cheaper with a lower copay. For weight loss, Wegovy could be covered by some Advantage plans.

Novo Nordisk’s savings card doesn’t work for Medicare, but programs like Extra Help or patient assistance can lower costs to $25 per month. Another option is compounded semaglutide, which costs around $200–$300 out of pocket.

How to Check and Lower Your Ozempic Costs with Medicare

Use Medicare’s Plan Finder at Medicare.gov to compare 2025 plans. Just enter your ZIP code, medications, and pharmacy to see plans and costs. Check your Annual Notice of Change for updates to your current plan.

You can switch plans during Open Enrollment (Oct 15–Dec 7). If you have a low income, you may qualify for Extra Help which can lower your costs to as little as $0.

Challenges and Appeals Process

Facing challenges like prior authorization denials for off-label use, high deductibles, or medication shortages? Here’s what you can do:

Appeal denials: Provide medical evidence, like a diabetes diagnosis, and file your appeal within 60 days. Legitimate cases have a 40-60% success rate.
Get assistance: Call 1-800-MEDICARE or reach out to a SHIP counselor for free help with navigating appeals or finding more affordable plans.

Don’t hesitate to seek support. Help is available

Conclusion

Medicare will make Ozempic more affordable for most diabetes patients which costs around $0–$100 per month due to the $2,000 yearly cap on out-of-pocket costs. However, coverage for weight loss is still limited. Be sure to compare plans each year and use savings tools. Talk to your doctor to find the best option for you.

FAQs

How much does Ozempic cost with Medicare Part D in 2025?

With Part D, Ozempic costs $0–$100 a month for diabetes after the deductible (up to $590). There’s a $2,000 yearly cap—$0 after that. Total costs are usually $500–$1,000 a year, depending on your plan.

Does Medicare cover Ozempic for weight loss in 2025?

No, Medicare Part D and most Advantage plans don’t cover Ozempic for weight loss—it’s seen as cosmetic. Some Advantage plans may help with obesity care, but it usually needs a diabetes diagnosis.

What is the $2,000 out-of-pocket cap for Ozempic on Medicare?

You’ll pay no more than $2,000 out-of-pocket for drugs covered by your Part D plan. Once you reach that limit, you’ll pay $0 for the rest of the year. This helps people who use expensive drugs like Ozempic for diabetes.

How can I lower Ozempic costs with Medicare?

Pick a low-cost plan with good drug coverage. If you have a low income, see if you can get Extra Help. You can also get a 90-day supply by mail to save money. If your plan says no, you can appeal or change plans during Open Enrollment.

Does Medicare Advantage cover Ozempic better than Part D?

Some Advantage plans offer $0-50 copays or extras like weight loss programs with GLP-1s in some areas. Check Plan Finder for details—offers vary by insurer like Humana or Aetna.