Does Medicare cover a diabetes prevention program?

What is the Medicare Diabetes Prevention Program?

The Medicare Diabetes Prevention Program is a health behavior change program, covered by Medicare Part B, to help you prevent type 2 diabetes. The program has 16 sessions, one a week within a 6-month period. In these sessions, you get:

• A specially trained coach to help keep you motivated
• Training to make realistic, lasting behavior changes around diet and exercise
• Tips for getting more exercise
• Strategies to control your weight
• Support from people with similar goals and challenges, if you take part in person or through distance learning

Who qualifies for the Medicare Diabetes Prevention Program?

You qualify if you have Part B (or a Medicare Advantage Plan), you're at risk for developing type 2 diabetes, and all of these apply to you:

• Within 12 months before your first core session, you had a hemoglobin A1c test result between 5.7% and 6.4%, a fasting plasma glucose of 110-125 mg/dL, or a 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test).
• You have a body mass index (BMI) of 25 or more, or 23 or more if you're Asian.
• You've never been diagnosed with type 1 or type 2 diabetes or End-Stage Renal Disease (ESRD).

What does the program cost, and how often can I take it?

You pay nothing for the Medicare Diabetes Prevention Program if you qualify. There's no limit to the number of times you can take part. After the first 6 months, you get 6 follow-up sessions, one a month for 6 months, to help you keep up healthy habits.

How do I join a Medicare Diabetes Prevention Program?

Check with your doctor to find out if you're eligible, then choose an approved Medicare Diabetes Prevention Program supplier. Suppliers may be traditional health care providers or organizations like community centers or faith-based organizations, and Medicare.gov has a search tool that lets you filter by class format. You can take part through any of these formats:

• Distance learning (you attend live sessions online)
• Self-paced (you complete sessions online, any time)
• In person

Does Medicare Advantage change how I get the program?

If you're in a Medicare Advantage Plan, you may have to go to an in-network provider to get the Medicare Diabetes Prevention Program, so contact your plan for more information. Medicare Advantage plans must cover all medically necessary services that Original Medicare covers; other rules and costs vary by plan.

What does Medicare cover if I already have diabetes?

If you've been diagnosed with diabetes, Medicare Part B covers outpatient diabetes self-management training when your doctor or other health care provider orders it. The training may include tips for eating healthy and being active, monitoring blood sugar, taking prescription drugs and reducing risks.

Medicare covers up to 10 hours of initial training, made up of 1 hour of individual training and 9 hours of group training, and you may qualify for up to 2 hours of follow-up training each calendar year after the year of your initial training. You pay 20% of the Medicare-approved amount after the Part B deductible. Some people with diabetes also qualify for medical nutrition therapy.