Who qualifies for a GLP-1
For weight loss, the criteria clinicians generally apply are simple: a BMI of 30 or higher, or a BMI of 27 or higher if you also have at least one weight-related health condition. Those thresholds come from the trial populations; the FDA labels themselves describe the population in words, as obesity, or overweight with at least one weight-related condition, without naming a number. The checker above calculates your BMI and applies those thresholds, then tells you which side of the line you’re on.
Age decides which products apply, and it is not a footnote
BMI is only half the question. The four weight-management products do not share one population, and the differences are large enough to change the answer:
| Product | Youngest approved | Note |
|---|---|---|
| Wegovy injection | 12 | Pediatric indication is for obesity |
| Saxenda | 12 | Also requires body weight above 60 kg |
| Zepbound | 18 | Adults only |
| Foundayo | 18 | Label states effectiveness in pediatric patients is not established |
Two consequences worth spelling out. A 15-year-old with obesity has two options, not four. And the overweight-plus-a-condition route is adults only on every one of them, because the pediatric indications cover obesity alone, so a teenager with a BMI of 28 and high blood pressure is not in any of these populations. The checker now asks for your age for exactly this reason.
The weight-related conditions that lower the threshold from 30 to 27 include type 2 diabetes (or prediabetes), high blood pressure, high cholesterol, obstructive sleep apnea, and heart disease. If you have any of them and a BMI in the 27–29.9 range, you meet the usual medical criteria, and a clinician just needs to confirm the diagnosis.
These are the criteria for the weight-management drugs specifically: Wegovy, Zepbound, Saxenda, and Foundayo. The diabetes GLP-1s (Ozempic, Mounjaro, Rybelsus, Victoza, Trulicity) are approved on different criteria, and several also carry cardiovascular or kidney indications. Prescribing any of them for weight loss is off-label, which a clinician can do at their discretion.
The three thresholds
| Your situation | Do you meet the standard criteria? |
|---|---|
| BMI 30 or above | Yes, on BMI alone |
| BMI 27–29.9 with a weight-related condition | Yes |
| BMI 27–29.9 with no such condition | Not by the standard criteria |
| BMI under 27 | Generally no (talk to a clinician about exceptions) |
Qualifying medically vs. getting it covered
This is the distinction that catches most people off guard: meeting the clinical bar and getting your insurance to pay are two different things. This tool checks the medical bar, whether a clinician can appropriately prescribe the drug for you. Coverage is a separate hurdle, and it’s often higher. Some plans demand a BMI above 30, documented prior weight-loss attempts, or exclude anti-obesity medications altogether.
So you can absolutely qualify medically and still get a coverage denial. If that’s you, the insurance checker walks through your options, and appeals and prior authorizations succeed more often than people expect.
The third bar: Medicare’s GLP-1 Bridge
Medicare Part D still cannot cover a drug used for weight loss. That statutory bar has not moved. What changed is that since 1 July 2026 CMS has run a separate, time-limited program, the Medicare GLP-1 Bridge, giving eligible beneficiaries certain products for a flat $50 a month, scheduled to run through 31 December 2027. It is not Part D coverage, and CMS says so explicitly.
It matters here because it is the only one of the three bars with published numeric criteria, and they are not the 30/27 numbers above. There are three tiers, and all of them are assessed at the point GLP-1 therapy started rather than when the request is filed:
| Tier | Qualifies |
|---|---|
| BMI 35 or above | On BMI alone |
| BMI 30 or above | Plus heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or above |
| BMI 27 or above | Plus pre-diabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease |
Three things rule it out, and they work differently from each other. Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic MASH each rule it out on the diagnosis alone, even when every other criterion is met, because Part D can already cover those. Any GLP-1 paid for by a Medicare drug plan this calendar year, for any reason, rules it out on its own, and that is the filter most write-ups leave out. And cardiovascular disease works differently again: having had a heart attack is a qualifying condition, but a prescription written to reduce cardiovascular risk routes to Part D instead. It is what the prescription is for that decides, not what is in your chart.
The checker above has a Bridge section that walks these. Note that the program has no appeals process, though a corrected request can be resubmitted, and your Part D appeal rights are unaffected.
BMI’s limitations
BMI is a blunt instrument. It’s a ratio of weight to height that says nothing about body composition. A very muscular person can have a “high” BMI with little excess fat, and BMI can misjudge risk differently across ages and ethnicities. It’s the criterion the labels and insurers use, so it’s what this checker applies, but it isn’t the whole picture of your health. A good clinician looks at your waist circumference, lab work, and history alongside it.
The bottom line
Use this to walk into a conversation informed about where you stand against the criteria. But eligibility isn’t a self-diagnosis. A licensed provider makes the final call, confirms any conditions, and decides what’s appropriate for you. This tool is educational and not medical advice.