Medicare Open Enrollment 2027: Your $50 GLP-1 Bridge Runs Through 2027
If you're on Medicare's $50 GLP-1 Bridge, you do not need to switch plans this fall to keep it. CMS has extended the Bridge through December 31, 2027, and the BALANCE Model will not launch in Part D in 2027. What you do need to do before December 7 is keep some form of Part D drug coverage and pick a plan that still works for every other drug you take.
Key takeaways
- The Medicare GLP-1 Bridge now runs July 1, 2026 through December 31, 2027, per CMS's BALANCE Model page. It was originally set to end in December 2026.
- The Bridge runs outside your Part D plan, so access does not depend on which plan you pick. But you must be enrolled in Part D coverage of some kind.
- Dropping drug coverage, or moving to a Medicare Advantage plan without drug coverage, is the main open-enrollment move that could cost you Bridge access.
- If your GLP-1 is covered by your Part D plan for diabetes, sleep apnea, or heart risk instead, plan choice matters a lot. Check each plan's formulary before you switch.
- The Bridge's $50 copay does not count toward the Part D out-of-pocket cap, which rises from $2,100 in 2026 to $2,400 in 2027.
What changed: the Bridge didn't end
When CMS first announced it, the Bridge was described as a six-month program that would hand off to a new BALANCE Model in January 2027. That plan changed. On April 21, 2026, CMS issued a status update on the Bridge and BALANCE for 2027, according to the Academy of Managed Care Pharmacy. The Part D side of BALANCE was delayed "pending further evaluation and data collection," and the Bridge was extended through the end of 2027.
CMS's own Medicare GLP-1 Bridge page now lists the program as running July 1, 2026 through December 31, 2027, and ties the extension to BALANCE not launching in 2027. The BALANCE page, last modified September 29, 2026, says the same: "The Medicare GLP-1 Bridge has been extended through December 31, 2027."
Why the delay? CMS didn't say directly. KFF reports that too few Part D plan sponsors reportedly signed up to meet CMS's 80% participation threshold. TechTarget noted that large insurers had not committed and that 2027 plan bids were due June 1. The Medicaid side of BALANCE is still moving ahead, but that doesn't affect people on Medicare.
| Item | Original plan | Current status (Oct 19, 2026) |
|---|---|---|
| Bridge end date | December 31, 2026 | December 31, 2027 |
| BALANCE in Medicare Part D | Starting January 2027 | Not launching in 2027; no new date set |
| Need a "participating" Part D plan? | For BALANCE, yes | No. The Bridge works with any Part D plan |
| Bridge copay | $50 per month | $50 per month |
| Prior authorization | Through central processor | Valid through Dec 31, 2027 unless you switch GLP-1s |
Source: CMS Bridge page, CMS BALANCE page, Medicare.gov GLP-1 Bridge.
How the Bridge works, and why your plan choice mostly doesn't affect it
The Bridge sits outside the normal Part D benefit. Per CMS, Part D sponsors bear no risk for Bridge drugs and don't have to opt in for their members to use it. A single central processor handles prior authorization and pharmacy claims. KFF puts it plainly: access doesn't depend on which Part D plan you have.
Here's what Medicare.gov lists for the Bridge:
- Drugs: Foundayo (tablet), Wegovy (injection or tablet), and Zepbound KwikPen only. Zepbound single-dose vials and pens aren't covered.
- Cost: $50 per 28- or 30-day supply.
- Who qualifies: Adults with a BMI of 35 or higher; a BMI of 30 or higher plus diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure, or stage 3a or worse kidney disease; or a BMI of 27 or higher plus prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
- Who doesn't: People who already get a GLP-1 covered through their Part D plan, and people with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease. Their Part D plan may cover a GLP-1 for those conditions instead.
- Prior authorization: Valid through December 31, 2027, including refills and dose changes, unless you change GLP-1s.
The coverage types that qualify are standalone drug plans (PDPs), Medicare Advantage plans with drug coverage (MA-PD), Special Needs Plans, employer or union retiree plans that provide Part D (EGWPs), and the LI NET program, per Medicare.gov's weight-loss drug page.
Not on a GLP-1 yet?
Compare GLP-1 care options, and check whether a provider accepts Medicare before you book.
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The open-enrollment moves that can cost you Bridge access
Because the Bridge requires Part D coverage, a few common plan changes can quietly take you out of it. Medicare Open Enrollment runs October 15 to December 7, and changes take effect January 1, per Medicare.gov. Watch for these:
- Moving to a Medicare Advantage plan without drug coverage. Some $0-premium MA plans don't include Part D. The Bridge lists MA plans with drug coverage, not MA plans without it.
- Dropping your standalone drug plan. If you're in Original Medicare and drop your PDP to save on premiums, you lose the Part D coverage the Bridge depends on.
- Leaving a retiree plan. Employer or union retiree plans that offer Part D (EGWPs) qualify. If you leave one, make sure your new coverage includes Part D.
Medicare.gov doesn't say whether switching from one Part D plan to another forces a new Bridge prior authorization. Since the authorization runs through a central processor rather than your plan, it shouldn't be tied to your old plan. But this isn't stated outright, so call 1-800-MEDICARE (1-800-633-4227) to confirm before you switch.
If your GLP-1 runs through your Part D plan instead
This is where open enrollment matters most. Men with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease are excluded from the Bridge and get their GLP-1 through regular Part D coverage instead. KFF notes that people already covered by Part D for a Medicare-covered use, including cardiovascular risk reduction, keep getting the drug through their plan.
For these men, the 2027 plan you choose decides:
- Whether your specific drug (Ozempic, Mounjaro, Wegovy, Zepbound) is on the formulary at all.
- Which tier it sits on, and whether you pay a flat copay or a percentage of a high list price.
- Prior authorization and step-therapy rules, which can differ from plan to plan.
Use the Medicare Plan Finder and enter every drug and dose you take, not just the GLP-1. Then call the plan and ask how it covers your GLP-1 for your specific diagnosis. A plan that covers Zepbound for sleep apnea won't necessarily cover it the same way for another use.
The money side: deductible, cap, and what the $50 doesn't count toward
Part D's cost limits go up in 2027. According to Medicare.gov, no plan's deductible can exceed $615 in 2026 or $700 in 2027. The out-of-pocket threshold, where catastrophic coverage starts, is $2,100 in 2026 and $2,400 in 2027.
| Part D limit | 2026 | 2027 |
|---|---|---|
| Maximum deductible | $615 | $700 |
| Out-of-pocket threshold (cap) | $2,100 | $2,400 |
| Bridge copay counts toward these? | No | No |
Source: Medicare.gov, Costs for Medicare drug coverage; Medicare.gov GLP-1 Bridge.
The Bridge copay sits outside all of that. Medicare.gov says the $50 doesn't count toward your deductible or out-of-pocket limit, doesn't appear on your Explanation of Benefits, can't be lowered by Extra Help, and can't be spread out through the Medicare Prescription Payment Plan. Budget it as a separate $600 a year ($50 times 12 fills) on top of whatever your plan charges for your other drugs.
For a man on a Bridge GLP-1 plus blood pressure, cholesterol, and prostate meds, this means the cheapest plan for 2027 is the one that's cheapest for those other drugs. The GLP-1 cost stays $50 either way.
A December 7 checklist
- Read your plan's Annual Notice of Change. Plans mail it each fall. Look for formulary, tier, and pharmacy network changes for 2027.
- Confirm which route covers your GLP-1. Is it the Bridge (you got a confirmation letter, you pay $50) or your Part D plan? The checklist is different for each.
- Bridge users: make sure every plan you're considering includes Part D. Then compare on your other drugs, premiums, and pharmacies.
- Part D–covered users: check your GLP-1's formulary status, tier, and prior authorization rules on every plan you're considering.
- Check your pharmacy. A plan change can move your preferred pharmacy out of network for your other prescriptions.
- Call to confirm. Use 1-800-MEDICARE for Bridge questions and the plan's member line for formulary questions. Write down who you spoke with and when.
If you're already in a Medicare Advantage plan and make a choice you regret, the Medicare Advantage Open Enrollment Period (January 1 to March 31) lets you switch MA plans or return to Original Medicare and add a drug plan, per Medicare.gov. People in Original Medicare don't get that second window, so get it right by December 7.
What happens after 2027
Nobody knows yet. KFF says Medicare coverage of GLP-1s for obesity after 2027 is unclear unless the Bridge is extended again or BALANCE is implemented. CMS describes the delay as giving it time to collect data on GLP-1 use. Expect this question to come back during next year's open enrollment, in fall 2027.
Where this guide stops
This article covers plan selection as it relates to GLP-1 access. It doesn't replace a review of your full drug list, and it isn't legal or insurance advice. Medicare rules for 2027 can still be clarified by CMS before January, and individual plan formularies vary by state and county. State Health Insurance Assistance Programs (SHIPs) offer free, unbiased Medicare counseling if you want a second set of eyes.
Questions to bring to your prescriber and plan
- To your prescriber: "Am I on the Bridge, or is my GLP-1 covered by my Part D plan for a specific diagnosis?"
- To your prescriber: "If I'm thinking of switching GLP-1s in 2027, will that require a new Bridge prior authorization?"
- To 1-800-MEDICARE: "If I switch from one Part D plan to another for 2027, does my Bridge authorization carry over?"
- To the plan: "Is my GLP-1 on your 2027 formulary for my diagnosis, at what tier, and with what prior authorization rules?"
Compare GLP-1 care options
See providers' current terms and pricing; a consult is not a guarantee of a prescription.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
Frequently asked questions
Does the Medicare GLP-1 Bridge end on December 31, 2026?
No. CMS extended the Bridge through December 31, 2027, and the BALANCE Model will not launch in Medicare Part D in 2027.
Do I need to switch to a BALANCE plan to keep my $50 GLP-1?
No. No Part D plan is in BALANCE for 2027. The Bridge runs outside the Part D benefit, so access doesn't depend on which Part D plan you have, as long as you have Part D coverage of some kind.
What plan changes could cost me Bridge access?
Dropping your drug plan, moving to a Medicare Advantage plan without drug coverage, or leaving a retiree plan without picking up other Part D coverage. The Bridge requires Part D coverage such as a standalone drug plan or an MA plan with drug coverage.
Does the $50 Bridge copay count toward the Part D out-of-pocket cap?
No. Medicare.gov says the Bridge copay doesn't count toward your Part D deductible or out-of-pocket limit, which is $2,400 in 2027, and Extra Help can't lower it.
What if my GLP-1 is covered for diabetes or sleep apnea?
People with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease are excluded from the Bridge and may get a GLP-1 through their Part D plan instead. For them, each plan's 2027 formulary, tier, and prior authorization rules matter, so compare carefully before December 7.
Sources
- CMS: BALANCE Model (last modified Sept 29, 2026)
- CMS: Medicare GLP-1 Bridge
- Medicare.gov: Medicare GLP-1 Bridge
- Medicare.gov: Weight loss drugs
- Medicare.gov: Costs for Medicare drug coverage
- Medicare.gov: Joining a plan
- Medicare.gov: Medicare Plan Finder
- AMCP: CMS Issues Status Update on the BRIDGE Demo and BALANCE Model in Part D for CY 2027
- KFF: What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge
- TechTarget: CMS benches BALANCE Model for Medicare
Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.