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Medicare Diabetes Prevention Program

Medicare Expands Diabetes Prevention Services

Diabetes has been high on the radar of health professionals of late. Over 84 million Americans have prediabetes, and up to a quarter of those will develop Type 2 within 5 years. 

New findings have shown that diabetes can be prevented through a proven lifestyle-change program called the Diabetes Prevention Program, recently expanded to the Medicare Diabetes Prevention Program. 

In 2018, Diabetes Prevention services will be covered by Medicare up to $670 per beneficiary. The goal is to save people from developing the disease, which will in turn save money on the care spent on people with diabetes. 

Background on the program

In March of 2016, the Department of Health and Human Services (HHS) announced that it would roll out a plan to cover programs that aim to prevent diabetes. As part of the six-year anniversary of the Affordable Care Act, the announcement noted that Medicare would reimburse providers recognized by the Centers for Disease Control (CDC) when they administered the Diabetes Prevention Program (DPP), leading to the new name: the Medicare Diabetes Prevention Program (MDPP). While it feels like a lifetime since that news broke, the estimated start of the program is near: April 2018.

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 U.S. 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 experts who are trained health professionals.

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What do participants do?

Participants are educated on keeping themselves healthy in order to avoid developing diabetes. The central program consists of 16 weekly, hour-long sessions during a 12-month span. Beneficiaries of the program will also have the opportunity to participate in three-month intervals of ongoing maintenance sessions after the 12-month program if they maintain a required minimum weight loss of 5 percent in the preceding three months.

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 percent, 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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