Does Medicare cover the Diabetes Prevention Program?

The Medicare Diabetes Prevention Program is a health behavior change program to help you prevent type 2 diabetes. The first part of the program lasts 6 months and includes 16 core sessions. Medicare Diabetes Prevention Program sessions are held in a group setting and provide the following:

• Training to make realistic, lasting behavior changes to improve health
• Tips on how to get more exercise
• Strategies for controlling your weight
• A behavior coach, specially trained to help keep you motivated
• Support from people with similar goals

After you complete the 16 core sessions, you continue to receive help and support, including the following:

• 6 monthly follow-up sessions to help you maintain healthy habits
• An additional 12 months of maintenance sessions if you meet certain goals

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

1. You have a high blood glucose test result including one of the following:

• Hemoglobin A1c (HbA1c) between 5.7 and 6.4 percent;
• Blood glucose of 110-125mg/dL when fasting (not eating or drinking for at least 8 hours); or a 2-hour plasma glucose (oral glucose tolerance test) of 140-199mg/dL within 12 months of attending the first program session.

2. Your body mass index (BMI) is 25 or more (23 or more if you’re Asian).

3. You have never been diagnosed with type 1 diabetes, type 2 diabetes or End-Stage Renal Disease (ESRD). Medicare Advantage plans (Part C) also cover the Medicare Diabetes Prevention Program. Talk to your plan provider for coverage details.

The Medicare Diabetes Prevention Program is a covered preventive service. That means you pay nothing and the Medicare Part B deductible does not apply.

However, you must attend a “recognized” program – one that meets all the standards set by the Centers for Disease Control and Prevention (CDC) and is a recognized Medicare supplier for the benefit. Programs that do not have this designation may not be covered.

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