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Medicare Launches Diabetes Prevention Program

Over 84 million Americans have prediabetes, and up to a quarter of those will develop type 2 diabetes within 5 years. For every $3 Medicare spends, $1 is spent on diabetes care and management. Studies show that diabetes can be prevented and prediabetes can be reversed with a lifestyle change of healthy diet and exercise. Medicare’s solution to cut diabetes spending and improve the health of beneficiaries is the Medicare Diabetes Prevention Program (MDPP), which launched April 1st.

How it works

The Medicare Diabetes Prevention Program takes place over 12 months and educates participants on how to stay healthy and avoid developing diabetes. For the first 16 weeks, participants meet for weekly hour-long sessions known as “core sessions.” After that, participants meet monthly. Once the first year has ended, beneficiaries have the opportunity to participate in quarterly maintenance sessions if they maintain a required minimum 5% weight loss. The program has been proven to reduce the development of diabetes by 71% for those age 65 and older, and it saves Medicare $2,650 per beneficiary over 15 months.

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Why it’s necessary

More than 25 percent of Americans 65 years of age or older are affected by diabetes, and that number is expected to double for all US adults (ages 18-79) by 2050 if current trends continue, according to the Centers for Medicare and Medicaid Services (CMS). Hence, the MDPP aims to use a “structured behavioral change intervention” program to prevent the onslaught of type 2 diabetes among senior citizens. This means providing Medicare beneficiaries with access to MDPP services in community and health care settings that are led by trained healthcare professionals.

Who is eligible

You are eligible for MDPP if you:

  • Are enrolled in Medicare Part B
  • Have a body mass index (BMI) of at least 25 (if not self-identified as Asian) or at least 23 (if self-identified as Asian)
  • Have a hemoglobin A1c test with a value between 5.7% and 6.4%, a fasting plasma glucose of 110-125 mg/dL, or a two-hour plasma glucose of 140-199 mg/dL
  • No previous diagnosis of type 1 or type 2 diabetes, except gestational diabetes
  • Do not have end-stage renal disease (ESRD)

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