Does the Diabetes Prevention Program have Medicare coverage?

What is the Diabetes Prevention Program under Medicare?

The Medicare Diabetes Prevention Program is a health-behavioral change program designed to assist you to avoid developing type 2 diabetes. The first six months of the curriculum are comprised of 16 core sessions. Sessions of the Medicare Diabetes Prevention Program are held in a group environment and include the following benefits:

Training to help people achieve realistic, long-term behavioral adjustments to improve their health.

Suggestions on how to increase your physical activity

Weight-reduction strategies

A behavior coach who has been properly trained to assist you in staying motivated.

People who share your aim can help you.

Following the completion of the 16 core sessions, you will continue to get assistance and support, which includes the following:

  • 6 monthly follow-up appointments to aid with the maintenance of good habits
  • If you reach specific targets, you will receive an additional 12 months of maintenance sessions.

How Does Medicare Pay for the Diabetes Prevention Program?

If all three of these conditions apply, Medicare Part B (medical insurance) provides one-time coverage for the Medicare Diabetes Prevention Program:

  1. You have a high blood glucose test result that includes one or more of the following factors.
  • Between 5.7 and 6.4 percent hemoglobin A1c (HbA1c);
  • Within 12 months of attending the first programmer session, blood glucose of 110-125mg/dL when fasting (without eating or drinking for at least 8 hours); or a 2-hour plasma glucose (oral glucose tolerance test) of 140-199mg/dL.
  1. Our body mass index (BMI) is 25 or greater (23 or greater if Asian).
  2. You’ve never had type 1 diabetes, type 2 diabetes, or End-Stage Renal Disease (ESRD) (ESRD). The Medicare Diabetes Prevention Program is covered through Medicare Advantage plans (Part C). For more information about your plan’s coverage, contact your provider.

The Medicare Diabetes Prevention Program is a preventive programmer that is covered by Medicare. That implies you don’t have to pay anything and the Medicare Part B deductible is waived.

What is the cost of the Medicare Diabetes Prevention Program?

The Medicare Diabetes Prevention Program is a preventive program that is covered by Medicare. That implies you don’t have to pay anything and the Medicare Part B deductible is waived.

​You must, however, enroll in a “certified” program – one that fulfils all the Centers for Disease Control and Prevention (CDC) guidelines and is a recognized Medicare supplier for the benefit. It’s possible that programs that don’t have this designation won’t be covered.

For more information about the Medicare Diabetes Prevention Program, please visit: www.medicare.gov.

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