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States, plans and manufacturers opt in; Medicaid as early as May 2026, Medicare Part D in January 2027.
CMS announced the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model on December 23, 2025. Participation is voluntary for manufacturers, states and plans, so coverage depends on whether your state or plan joins. Medicaid participation can start as early as May 2026 and Medicare Part D in January 2027. A separate Medicare demonstration starting July 2026 lets eligible beneficiaries pay $50 for a month of GLP-1 medication.