Does Medicare Cover Diabetes Self-Management Training?
If you’ve been diagnosed with diabetes, Medicare Part B will cover diabetes self-management training when prescribed by your doctor. This 10-hour course can teach you ways to better manage your condition and help prevent future complications.
What Is Diabetes Self-Management Training?
Diabetes self-management training, or DSMT, is a program that helps people manage their diabetes diagnosis to prevent additional complications.
If left untreated, diabetes can cause serious side effects, including kidney disease, eye disease and stroke.
The Balanced Budget Act of 1997 established Medicare coverage for DSMT services in an effort to reduce health care costs and improve health outcomes for diabetes patients.
DSMT classes often take place in a different setting outside your doctor’s office, such as at a hospital, clinic or medical office.
Diabetes self-management training incorporates your specific needs, goals and life experiences into a program guided by evidence-based standards.
A diabetes care and education specialist can help you create a plan to stay healthy while also giving you resources and ongoing support to incorporate that plan into your daily life.
According to the American Diabetes Association, the overall goals of diabetes self-management education are to support informed decision-making, self-care behaviors and facilitate collaboration with a health care team.
DSMT is not the same as medical nutrition therapy, a different service provided by Medicare that features a more intensive, comprehensive nutrition program.
- Use devices like blood glucose meters, insulin pens, pumps and continuous glucose monitoring devices.
- Incorporate nutritional management into your lifestyle.
- Find ways to integrate physical activity into your lifestyle.
- Use medications safely.
- Prevent, detect and treat acute and chronic complications.
- Develop coping skills to address the daily challenges of diabetes.
- Find and access cost-savings programs.
In 2017, there was 830 DSMT programs accredited by the American Association of Diabetic Educators along with an additional 2,066 sites associated with these programs.
Medicare Coverage of Diabetes Self-Management Training
Medicare Part B covers outpatient diabetes self-management training if you’ve been diagnosed with diabetes.
You must have a written note from your doctor or qualified practitioner to start your self-care training.
DSMT programs must be accredited as meeting quality standards by a CMS-approved national accreditation organization.
- Up to 10 hours of initial DSMT, including one hour of individual training and nine hours of group training.
- Up to two hours of follow-up training each year if it takes place the year following your initial training.
Group training may be substituted for individual training if group sessions aren’t available in your area, or if your doctor says you have special needs that would benefit from individual training sessions.
You may also be able to get DSMT from a practitioner as a telehealth service.
Cost of Diabetes Self-Management Training with Medicare
Medicare doesn’t consider DSMT a free preventive service because it helps you better manage a current condition.
Therefore, you will likely have some out-of-pocket cost if your doctor recommends DSMT.
You’ll pay 20 percent of the Medicare-approved cost, and the Part B deductible applies. You may owe less if you have secondary health insurance coverage, such as Medicaid.
6 Cited Research Articles
- Centers for Medicare & Medicaid. (2020, December). Medicare Diabetes Prevention & Diabetes Self-Management Training. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/DSMT-Fact-Sheet-909381Print-Friendly.pdf
- United Healthcare. (2020, February). Diabetes outpatient self-management training (NCD 40.1). Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/d/diabetes-outpatient-self-management-training.pdf
- Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
- Funnell, M. et al. (2008). National Standards for Diabetes Self-Management Education. Retrieved from https://care.diabetesjournals.org/content/31/Supplement_1/S97
- Association of Diabetes Care & Education Specialists. (n.d.). How a Diabetes Care and Education Specialist Can Help You. Retrieved from https://www.diabeteseducator.org/living-with-diabetes/how-a-diabetes-educator-can-help-you
- Medicare.gov. (n.d.). Diabetes self-management training. Retrieved from https://www.medicare.gov/coverage/diabetes-self-management-training