If you're on Medicare and have been diagnosed with obstructive sleep apnea, you may wonder what your treatment options are. While positive airway pressure (PAP) therapy, like CPAP, is usually the first treatment offered, other options exist. When sleep apnea is related to obesity, weight loss medications like Zepbound may help.
Some Medicare plans cover Zepbound, the name brand for tirzepatide, as a treatment for moderate-to-severe sleep apnea among adults with obesity. Zepbound has been approved by the U.S. Food and Drug Administration (FDA) to treat sleep apnea since December 2024. Learn more about how Zepbound helps treat sleep apnea and when it falls under Medicare coverage.
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How Does Zepbound Work for Sleep Apnea?
Zepbound can help alleviate sleep apnea symptoms among adults with obesity by promoting weight loss. People on Zepbound inject the medication beneath their skin at home once a week. The drug reduces appetite by activating two types of hormone receptors, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). People are instructed to eat less and become more physically active while on the drug, which also aids with weight loss.
Does Medicare Cover Zepbound for Sleep Apnea?
Currently, Medicare Part D covers Zepbound for some people with sleep apnea. Coverage may expand in 2026 and 2027.
Specifically, the FDA has approved Zepbound for adults with moderate-to-severe obstructive sleep apnea who are also obese. Medicare coverage of the drug applies to this group when there's evidence that the sleep apnea is weight-related. Coverage may also extend to adults with moderate-to-severe obstructive sleep apnea who do not have obesity but are considered overweight.
Because Zepbound is a drug, it is covered by Medicare Part D. Medicare Part D does not currently cover Zepbound for weight loss alone or any other weight loss drugs. However, all Medicare and Medicaid recipients with a Zepbound prescription are set to be eligible for lower prices in 2026 under an agreement between Eli Lilly, the manufacturer of Zepbound, and the U.S. government. New pilot programs are also underway intended to expand Medicare coverage for Zepbound when it is prescribed for weight loss only, beginning in 2027.
How Do You Get Medicare to Cover Zepbound for Sleep Apnea?
To receive Medicare coverage for Zepbound for sleep apnea, you must follow several steps.
- Enroll in Medicare Part D: Medicare Part D is an optional drug coverage program for people on Original Medicare or Medicare Advantage Plans. It covers both generic and name-brand prescription medications. You can use the Medicare plan comparison tool to confirm that your specific plan lists Zepbound in its formulary, which means it covers the drug.
- Receive a sleep apnea diagnosis: Currently, Medicare only covers Zepbound for obstructive sleep apnea. The disorder causes symptoms like snoring, excessive daytime sleepiness, and nighttime awakenings, and is diagnosed with an overnight sleep study in a lab or a home sleep apnea test (HSAT).
- Meet weight-related criteria: Zepbound is only approved for people who have obesity or overweight, and whose weight is thought to directly contribute to their obstructive sleep apnea. Obesity is defined as a body mass index (BMI) over 30 kilograms per square meter (kg/m2), and overweight is defined as a BMI between 25 and 30 kg/m2.
- Receive a Zepbound prescription for sleep apnea: Zepbound is a drug that requires a prescription from a doctor. Currently, Medicare will only cover Zepbound when it has been prescribed specifically for sleep apnea, not for general weight loss. Keep in mind that your doctor may prescribe CPAP therapy first, as it's still the first-line treatment for obstructive sleep apnea. Or, they may prescribe both treatments simultaneously.
- Receive a prior authorization: Prior authorization is often required before insurance will cover a Zepbound prescription. This is a form that must be completed by a doctor or sleep specialist and submitted before the medication is received. It can be time-consuming to get, however, and there's no guarantee of coverage.
What Medicare Plans Cover Zepbound?
Zepbound’s coverage falls under Medicare Part D, Medicare's optional prescription drug coverage program.
What Are Medicare’s Requirements for Zepbound Coverage?
Currently, Medicare only covers Zepbound for adults who have both moderate-to-severe obstructive sleep apnea and obesity. In some cases, Medicare may also cover adults with moderate-to-severe obstructive sleep apnea who are overweight. The obstructive sleep apnea diagnosis must be confirmed with a sleep study or home sleep apnea test.
In the future, Medicare may cover Zepbound for weight loss alone, but currently does not.
How Much Does Zepbound Cost With Medicare?
As of 2025, Medicare has a $2,000 annual cap on what Medicare recipients can pay for prescription drugs covered by Medicare Part D. This means that people prescribed Zepbound covered by Medicare won't pay more than $2,000 a year for it, which comes out to an average of $160 to $190 a month and is much less than the medication's full price.
Tentatively beginning in April 2026, people on Medicare who take Zepbound are set to pay as little as a $50 monthly co-pay to receive their medication after their deductible has been met. This new price cap is the result of an agreement between the drug’s manufacturer, Eli Lilly, and the U.S. government.
How Do You Check if Your Medicare Plan Covers Zepbound?
Medicare's online plan comparison tool allows you to check if your plan covers Zepbound for sleep apnea. You can also call the phone number on your Medicare card or begin a chat from the Medicare.gov home page to ask about your plan's drug coverage details.
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Written by
Cassandra Burns, Contributing WriterCassandra is a health writer who writes about sleep products and reads emerging research to develop science-based articles that help demystify the connection between health and sleep. She's happy to report that she sleeps well most nights, which is probably thanks to her energetic dog and her other work managing a family-owned whitewater rafting business in Upstate New York.
Reviewed by
Pranshu Adavadkar, MD, Medical ReviewerAs a board-certified sleep medicine physician with over 20 years of clinical experience, Dr. Adavadkar is an expert in diagnosing and treating sleep disorders in both children and adults, as well as addressing sleep issues experienced by veterans. While practicing primary care after completing his pediatric residency at John H. Stroger Jr. Hospital of Cook County in Chicago, he developed a strong passion for sleep medicine. He observed the prevalence and intricacy of sleep problems and the significant effect they had on his patients\' and their families\' well-being, leading him to recognize this as a field where he could make a meaningful impact on people\'s lives.
