What is the Medicare Diabetes Prevention Program?

Medicare Benefits Solutions
Apr 8, 2022

Can you prevent diabetes? While Type 1 diabetes is caused by the body’s inability to produce insulin and can be diagnosed in anyone regardless of age, race, or lifestyle, type 2 diabetes may be prevented or treated with a healthy diet and exercise.

But, it’s not always as easy as it may sound. Fortunately, the Medicare Diabetes Prevention Program may help you make the changes you need to prevent type 2 diabetes.

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What is Diabetes?

Diabetes is a disease that affects your body’s capacity to convert food into energy. Normally, glucose (sugar) enters your body through food, travels through your bloodstream and enters cells to generate energy. A hormone that your pancreas produces, insulin, helps this process along.

When you have diabetes, insulin is not produced (Type 1) or used effectively (Type 2). As a result, glucose builds up in your blood, a condition commonly referred to as high blood sugar, which exposes you to multiple health issues like heart disease, vision problems, nerve damage and kidney disease.

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What is Prediabetes?

The most common form of diabetes is Type 2. Most people have prediabetes before the full development of Type 2 diabetes. A diagnosis of prediabetes means that your blood sugar count exceeds the normal range but not up to the level of diabetes. The Centers for Disease Control and Prevention (CDC) reports that 96 million adults have prediabetes, yet more than 80% are unaware that they have it.

Prediabetes should be taken seriously, but you don’t need to panic. Think of the diagnosis as an opportunity to pivot in the right direction and reverse the course of the disease by implementing dietary and activity changes.
If you have recently been diagnosed with prediabetes, know that you can prevent prediabetes from developing into Type 2 diabetes by adopting a few simple lifestyle modifications. Taking part in a Medicare Diabetes Prevention Program, a free program under Medicare Part B, is a step in the right direction.

Diabetes Prevention Program (DPP)

The National Institutes of Health (NIH) warns that your chances of developing Type 2 diabetes are higher if you are inactive and overweight. However, the good news coming out of an NIH-funded Diabetes Prevention Program (DPP) study is that “lifestyle changes resulting in modest weight loss sharply reduced the development of Type 2 diabetes in people at high risk for the disease.”

Researchers conducted the DPP study in 27 clinical settings across the United States from 1996 to 2001. The study results showed that participants in the DPP Lifestyle Change Program lowered their risk of developing Type 2 diabetes by 58%. A DPP Outcomes Study followed up with participants after 10 years and found that the age-60-and-older group successfully delayed the development of the disease by 49%.

National Diabetes Prevention Program

The 2010 National Diabetes Prevention Program, otherwise known as National DPP, grew out of the NIH DPP study. The program conjoins public and private organizations, such as federal agencies, private employers, insurance companies and the healthcare industry, to work toward the common goal of diabetes prevention.

To be eligible for the National DPP, you must be at least 18 years old, not be pregnant, have a body mass index (BMI) of at least 25 (23 if Asian) and have no history of Type 1 or Type 2 diabetes.
Examples are the YMCA Diabetes Prevention Program and the National Kidney Foundation. The aim is to encourage people with prediabetes to participate in lifestyle-change programs that implement a CDC-approved curriculum.

Medicare Diabetes Prevention Program (MDPP)

The Medicare Diabetes Prevention Program expanded model, launched in 2018, is a framework structured to prevent Type 2 diabetes in people showing signs of prediabetes.

Here is what the CDC-approved curriculum entails:

  • 16 intensive sessions
  • Six-month duration
  • Group classes in a classroom-style environment
  • Practical training: Long-term improvement in dietary habits, increase in physical activity, and learned behaviors that help you manage weight
  • Monthly follow-up meetings to help you maintain supportive strategies and behaviors
  • Primary goal of 5% weight loss

Medicare Prediabetes Program

The Medicare Diabetes Prevention Program coverage falls under Part B (medical insurance). This is a once-in-a-lifetime benefit for those who are eligible. Eligibility is contingent upon specific ranges of hemoglobin A1c and plasma glucose test results, a body mass index (BMI) of at least 25 (23 if Asian) and no history of diabetes or end-stage renal disease.

In addition to learning how to integrate positive behavioral changes into your day-to-day living, you get a trained coach to motivate you as well as group support. If you are eligible for the MDPP, you incur no out-of-pocket costs for the program.

To search for Medicare diabetes prevention program suppliers, check the CMS supplier map. However, be prepared that suppliers may be difficult to find, depending on where you live. According to the American Journal of Managed Care, “there is an inadequate supplier availability to reach the estimated 29.5 million Medicare beneficiaries with prediabetes,” noting that Michigan has the majority of MDPP sites in the U.S.

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Medicare Advantage Diabetes Prevention Program

Part C Medicare Advantage (MA) plans are an alternative to getting Medicare coverage. MA plans must include at least the same level of benefits as Original Medicare Part A and Part B, and many offer expanded services. For MDPP coverage, MA plans can choose to:

  • Contract with Medicare-participating MDPP suppliers
  • Offer members coverage for out-of-network services
  • Enroll as an MDPP supplier

If you are an MA plan member, contact your plan administrator to determine how your plan covers the MDPP.

Other Benefits for People with Diabetes

Medicare Part B covers diabetes preventive services, such as self-management training, and tests for glucose screening and glaucoma. Part B also covers therapeutic shoes, supplies for measuring blood glucose, and sensors for continuous glucose monitors. Part B requires a deductible ($233 in 2022) and 20% coinsurance.

Medicare Part D includes oral diabetes medication as well as insulin and related medical supplies. Check your Part D plan to confirm your coverage.

Staying Updated on the Medicare Diabetes Prevention Program

If you’re wondering how to get started, discuss the MDPP with your doctor and how it might help lower your risk of diabetes. If you want to receive automatic updates on the MDPP, you can subscribe to email updates offered by the Centers for Medicare & Medicaid Services (CMS).

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