Medicare Open Enrollment 2027: Keep Your GLP-1 Coverage

Medicare open enrollment GLP-1 questions are piling up this fall, and most of them come down to one worry: “If I change my drug plan for 2027, do I lose my $50 Wegovy or Zepbound copay?” The short answer is no, as long as you keep some form of Medicare drug coverage. Open enrollment runs from October 15 through December 7, 2026, and the choices you make during that window take effect January 1, 2027. This guide explains how the Medicare GLP-1 Bridge fits into that decision, what actually changed for 2027, and a short checklist so you pick a plan with confidence.

Medicare open enrollment GLP-1 basics: how the Bridge works

The Medicare GLP-1 Bridge is the temporary federal program that has covered Wegovy (injection and pill), Foundayo, and the Zepbound KwikPen for weight management at a flat $50 monthly copay since July 1, 2026. Our full guide to Medicare GLP-1 coverage in 2026 covers the BMI tiers and prior authorization steps in detail.

The detail that matters for open enrollment is this: the Bridge runs outside your Part D plan. According to the CMS Medicare GLP-1 Bridge page, the program operates outside the Part D benefit’s coverage and payment flow, plan sponsors carry no financial risk, and plans do not need to opt in. Your pharmacy bills a central processor run by CMS, not your insurer. That is why the $50 does not count toward your Part D deductible or out-of-pocket limit.

In practical terms, every Part D plan and every Medicare Advantage plan with drug coverage is a “Bridge plan.” There is no special plan to hunt for on Medicare.gov.

What changed for 2027 (and what did not)

Earlier reporting said Bridge participants would need to move into a Part D plan that joined the longer-term BALANCE Model for 2027. That is the source of most of the confusion. Here is the current status:

• The Bridge was extended through December 31, 2027. CMS announced in April 2026 that it was postponing the Medicare Part D portion of the BALANCE Model for 2027 and extending the Bridge for a full extra year instead.
• No Part D plan is offering BALANCE coverage in 2027. CMS told plan sponsors not to indicate BALANCE participation in their 2027 bids. So there is nothing to switch into.
• Your prior authorization carries over. An approved Bridge prior authorization stays valid through the end of 2027, including refills and dose changes, unless you switch to a different GLP-1.
• The clinical rules are unchanged. You still qualify based on your BMI when you started therapy, and people with type 2 diabetes, moderate-to-severe sleep apnea, or MASH still go through their regular Part D benefit instead.

During this Medicare open enrollment GLP-1 Bridge coverage follows you automatically, so it should not drive your plan choice at all. Choose the plan that handles your other prescriptions best, and your $50 GLP-1 copay comes along.

The one way to lose your GLP-1 coverage during open enrollment

The Bridge requires you to be enrolled in Medicare drug coverage: a standalone Part D plan, a Medicare Advantage plan that includes drugs, a Special Needs Plan, or an employer or union group waiver plan. If you drop drug coverage entirely, or switch to a Medicare Advantage plan without a Part D benefit, your Bridge eligibility ends with it.

A few scenarios worth double-checking before December 7:

• Moving from Original Medicare to Medicare Advantage. Confirm the new plan is an MA-PD plan (the “PD” means it includes drug coverage). Some MA plans, especially those built around private-fee-for-service or Medical Savings Accounts, do not include Part D.
• Letting a plan lapse. If your current plan is leaving your area, Medicare will usually enroll you in a replacement automatically, but verify it. A gap in Part D coverage is also a gap in Bridge coverage.
• Relying on employer coverage. Group waiver plans count, but a retiree plan that is not a Part D-equivalent plan may not. Ask your benefits office which one you have.

Medicare open enrollment GLP-1 checklist for 2027

Use these steps while you compare plans in the Medicare Plan Finder:

1. Read your Annual Notice of Change. It arrived in September and lists every 2027 change to your premium, deductible, and formulary. If your GLP-1 is covered through the regular Part D benefit (for example, Ozempic for diabetes), look for tier changes or new prior authorization rules.
2. Leave the Bridge drug out of the Plan Finder cost estimate. Because Wegovy, Foundayo, and the Zepbound KwikPen bill outside the plan, entering them will inflate every plan’s estimated cost and can steer you wrong. Enter your other medications only, then add the $600 a year ($50 x 12) mentally.
3. Know the 2027 Part D numbers. The out-of-pocket cap rises to $2,400 (from $2,100), and the maximum deductible rises to $700 (from $615). Remember that Bridge copays do not count toward either figure.
4. Check the pharmacy network. Your Bridge claim still runs through a pharmacy, so make sure the pharmacy you use is in the new plan’s network and has been able to process Bridge claims. Independent pharmacies have had mixed success with the central processor.
5. Do not switch medications during the transition. Changing from Wegovy to Foundayo, or vice versa, requires a fresh prior authorization. If a change is coming, coordinate it with your prescriber rather than letting it collide with a January plan change.
6. Save your Bridge approval letter and keep a dose and weight log. If a pharmacy’s system rejects a claim in January, that paperwork gets it fixed fast. You can log each shot or pill, your weight, and side effects free with Pep, and a clean history also helps your provider if you ever need to re-attest to your starting BMI.

What if you get a GLP-1 through Part D, not the Bridge?

Plenty of Medicare users take Ozempic or Mounjaro for type 2 diabetes, or Wegovy or Zepbound for sleep apnea or heart disease, under the normal Part D benefit. For you, open enrollment matters a lot more, because formularies and tiers change every year. Compare the 2027 tier, copay or coinsurance, and any quantity limits for your exact drug and dose. If a plan moves your medication to a non-preferred tier, your monthly cost can jump by hundreds of dollars, so run the numbers in the free GLP-1 cost calculator and compare that against the manufacturer self-pay prices in our GLP-1 cost guide.

If your new plan denies coverage in January, you have rights. Our guide on what to do when insurance denies Wegovy or Zepbound walks through the appeal process, and it applies to Part D plans too.

Planning past 2027

The Bridge is scheduled to end on December 31, 2027 unless CMS extends it again or revives the BALANCE Model. That means the fall 2027 open enrollment, not this one, is the season when GLP-1 coverage may genuinely depend on which plan you pick. Medicare Advantage members also get a second chance during the January to March MA open enrollment period each year. For now, the smartest Medicare open enrollment GLP-1 move is to keep good records, stay on a plan with drug coverage, and watch for CMS guidance next summer. If you are still working and your employer plan is changing, our guide to an employer dropping GLP-1 coverage covers how to compare that against Medicare.

For the official eligibility quiz and program details, see the Medicare.gov weight loss drugs page, or call 1-800-MEDICARE.

Medicare open enrollment GLP-1 FAQ

Do I need to switch Part D plans to keep my $50 GLP-1 copay in 2027?

No. The Bridge was extended through 2027 and still operates outside Part D, so any Part D or Medicare Advantage drug plan keeps you eligible. The BALANCE Model’s Part D component was delayed, so no plan is offering it for 2027.

Will my GLP-1 show up in the Medicare Plan Finder cost estimate?

Only if it is covered through your plan’s regular benefit (such as Ozempic for diabetes). Bridge-covered Wegovy, Foundayo, and the Zepbound KwikPen bill outside the plan, so leave them out of the estimate and add $50 a month separately.

Does the $50 Bridge copay count toward the 2027 Part D out-of-pocket cap?

No. The copay does not apply to your deductible or to the $2,400 cap, and it cannot be lowered by Extra Help or spread out with the Medicare Prescription Payment Plan.

This article is for educational purposes only and is not medical, legal, or insurance advice. Program rules can change; confirm details with Medicare.gov, your plan, and your healthcare provider.