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No. All of our services are at no cost to you.

If your services are at no cost, how do you get paid?

Health insurance agents may be compensated by the health plans upon enrollment. We take pride in our client-first approach. There is no obligation to enroll. No pressure, straightforward process.

I am turning 65 soon, when can I enroll in a Medicare Advantage Plan?

You can enroll up to three months before or after your birth month during the Initial Coverage Election Period (ICEP).

How soon can my coverage begin?

Coverage will begin on the first of the following month of your enrollment. For new Medicare beneficiaries who enrolled during ICEP, coverage will begin on the first of the month indicated on your Medicare card.

When is the Annual Enrollment Period (AEP)?

The annual enrollment period is October 15 - December 7. Coverage for enrollments during this time will begin January of the following year.

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The Medicare GLP-1 Bridge Program: What Agents Need to Know

By Advantage Insurance Advisors

Aug 10, 2026

Industry News · 4 min read

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CMS opened the Medicare GLP-1 Bridge Program on July 1, 2026. It runs through December 31, 2027 and covers select GLP-1 medications prescribed for weight loss, which Part D on its own is not permitted to do.

One structural detail drives everything else: the Bridge sits outside the Part D benefit. CMS runs prior authorization, claims, and payment through its own process. It will not behave like your client’s drug plan, and that is where most of the confusion is going to come from.

What is covered

Foundayo® — tablet.
Wegovy® — injection or tablet.
Zepbound® — KwikPen® only. Single-dose Zepbound vials and pens are not covered.

Raise the Zepbound restriction early with anyone already taking it. The KwikPen is in; the single-dose vials and pens are not.

Who qualifies

A beneficiary must be 18 or older and meet one of three thresholds when they start GLP-1 therapy:

BMI of 35 or higher, with no additional condition required.
BMI of 30 or higher, plus diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher.
BMI of 27 or higher, plus prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease (blocked arteries in the legs or arms).

Who is shut out

A beneficiary is not eligible if they already have a diagnosis covered under Part D, or if they are already getting a GLP-1 through their Part D plan. The program is nationwide, covering all states and U.S. territories, and is open to certain people with Medicare drug coverage.

What it costs, and the four things clients will not expect

The copay is a flat $50 and the deductible does not apply. Past that, the Bridge behaves unlike anything else your clients know:

It does not count toward TrOOP. Bridge spending moves nobody closer to catastrophic coverage.
Extra Help does not reduce it. A client with LIS pays the full $50.
It never appears on an EOB. Bridge claims do not touch the plan, so they show up in neither the plan’s claim system nor the member’s Explanation of Benefits.
The Medicare Prescription Payment Plan cannot spread it. The $50 cannot be broken across months.

Those four are where your phone rings. A client on Extra Help who expects a reduced copay, or anyone who checks an EOB and finds nothing there, calls their agent long before they call CMS.

How a client actually gets it

A primary doctor or other provider sends the prescription to the pharmacy and completes the prior authorization when asked.
The provider has to certify the drug is being used as part of a lifestyle program focused on diet and exercise.
The pharmacy may ask for the Medicare Number, or the last four digits of the Social Security Number, to process it.
The beneficiary receives a letter in the mail confirming the drug is covered under the Medicare GLP-1 Bridge.
The prior authorization holds through December 31, 2027, refills and dose changes included, unless they switch to a different GLP-1.

That last clause is easy to skim past. Switching GLP-1s restarts the authorization.

What to tell clients about cost

Push clients to ask their provider what a test, item, or service will cost before they agree to it. Providers sometimes recommend services Medicare does not cover, or offers less often than they are recommended, and the balance lands on the client. What they owe depends on other insurance they carry, what the doctor charges, whether the doctor accepts assignment, the type of facility, and where they get the service.

What this means for your book

This is a window, not a change to the benefit. It closes on December 31, 2027, and nothing in it alters what Part D itself may cover. The agents who handle it well will be the ones who get ahead of the four surprises above, because every one of them looks like a plan error to a client who does not know the Bridge sits outside their plan.

This is an educational summary for agent use only. It is not a complete description of the Medicare GLP-1 Bridge Program, and it is not medical, legal, or benefit advice. Program terms can change. Confirm current details at medicare.gov/coverage/weight-loss-drugs, or with the compliance team of your health plan(s), before advising a client. Source: CMS, "Weight loss drugs," as of August 5, 2026.