What is the Medicare Diabetes Prevention Program?
The Medicare Diabetes Prevention Program is designed to help you learn how to modify your health and habits to prevent type 2 diabetes. The program includes sessions and follow-ups that can last for up to two years, and Medicare will completely cover the program if you meet certain health requirements.
What Is the Diabetes Prevention Program?
The Medicare Diabetes Prevention Program is a preventive series of courses in a supportive environment designed to help people with prediabetes make beneficial health and lifestyle changes to avoid becoming diabetic.
You are prediabetic if your blood sugar is already elevated but not enough to classify you as having type 2 diabetes. More than a third of American adults have prediabetes. The Medicare Diabetes Prevention Program can help move you in the right direction so that you don’t eventually develop type 2 diabetes.
The program starts with at least 16 one-hour group sessions that span a period of six months. In a classroom-style setting, you will get tips, training and information to help you live a healthier lifestyle that you can actually sustain.
- Weight loss and weight control strategies
- Exercise tips
- A trained coach to help you
The program covers possible changes to your diet as well as exercise strategies. Exercise is critical to preventing diabetes since physical activity can lower your blood glucose levels and increase your body’s insulin sensitivity. According to the U.S. Centers for Medicare & Medicaid Services, the Diabetes Prevention Program has reduced the incidence of diabetes in people ages 60 and older by 71 percent.
After the initial six-month course is complete, you can get six monthly follow-up sessions to help make sure you are sticking to your diet and exercise plans. If you are meeting your goals, you can get up to a year of additional sessions after the first year.
Who Is Eligible for the Medicare Diabetes Prevention Program?
Medicare Part B will cover the Diabetes Prevention Program if you meet certain requirements. Since the courses are specifically designed to help people with prediabetes, you cannot have been previously diagnosed with type 1 or 2 diabetes or end-stage renal disease. Your body mass index (BMI) must also be at least 25, or 23 if you are of Asian descent. Medicare will only pay for you to do the Diabetes Prevention Program once in your lifetime, so this cannot be your second time enrolling in the program.
- A hemoglobin A1c test result between 5.7 and 6.4 percent
- A fasting plasma glucose test result of 110 to 125 mg/dL
- A 2-hour plasma glucose test result of 140 to 199 mg/dL
How to Enroll
The U.S. Centers for Medicare & Medicaid Services offers a map to search for the Diabetes Prevention Program supplier who is closest to you, along with their contact information.
You can switch your supplier even after you have begun your courses, but it’s important to remember that your one lifetime enrollment is in affect as soon as you begin, so Medicare will not pay for additional courses if you drop out and try to return later.
If you develop diabetes while you are enrolled in the program, you can continue your courses.
6 Cited Research Articles
- Harvard Medical School. (2021, February 3). The Importance of Exercise When You Have Diabetes. Retrieved from https://www.health.harvard.edu/staying-healthy/the-importance-of-exercise-when-you-have-diabetes
- U.S. Centers for Disease Control and Prevention. (2020, June 11). Prediabetes — Your Chance to Prevent Type 2 Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/prediabetes.html
- U.S. Centers for Medicare & Medicaid Services. (2018, October). Medicare Diabetes Prevention Program Expanded Model. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MDPP-MLN34893002.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Diabetes Prevention Program. Retrieved from https://www.medicare.gov/coverage/diabetes-prevention-program
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Map of MDPP Suppliers Furnishing MDPP Services. Retrieved from https://innovation.cms.gov/innovation-models/medicare-diabetes-prevention-program/mdpp-map
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Diabetes Prevention Program (MDPP) Beneficiary Eligibility Fact Sheet. Retrieved from https://innovation.cms.gov/files/fact-sheet/mdpp-beneelig-fs.pdf