People who are at risk of developing diabetes may benefit from enrolling in the Medicare Diabetes Prevention Program (MDPP).
The MDPP provides training on how to make behavioral changes to help protect against diabetes. The program is free for a person with Medicare Part B if they meet certain criteria.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The MDPP is a series of sessions that train a person on how to engage in lifestyle practices that may reduce their risk of developing type 2 diabetes.
It is a 12-month program that involves 6 months of weekly core sessions with a healthcare professional and then 6 months of follow-ups.
In the first part, an instructor conducts weekly core sessions in a group setting over the course of 6 months. People who attend can expect:
- tips on how to get enough exercise
- lessons in nutrition
- teaching on how to make lasting behavioral changes
- strategies for weight management
- coaching in motivation to make positive changes
- support from individuals who have similar goals
After the core sessions, the second part includes 6 monthly follow-up sessions to help maintain healthy habits.
The Centers for Disease Control and Prevention (CDC) includes the MDPP as part of its
Type 2 diabetes risk factors
- having overweight or obesity
- being over the
age of 45 - being physically active less than 3 times per week
- having a parent or sibling with type 2 diabetes
- having a history of gestational diabetes or having given birth to a baby over 9 pounds
An individual may enroll in MDPP if they meet certain conditions.
Medicare Part B covers MDPP once in a person’s lifetime if all of the following apply:
- The person has never participated in the program.
- The person has a body mass index (BMI) of 25 or higher. If someone is Asian, the BMI criterion is 23 or higher.
- The person has never received a diagnosis of type 1 or type 2 diabetes or end stage renal disease (ESRD).
In addition, a person must have one of the following blood test results within 12 months of the first core session:
- a hemoglobin A1c test result that falls between 5.7 and 6.4%
- a fasting plasma glucose reading of 110–125 milligrams/deciliter (mg/dL)
- a 2-hour plasma glucose reading of 140–199 mg/dL
Both Original Medicare (Part A and Part B) and Medicare Advantage (Part C) provide coverage.
Original Medicare
Part B covers services and supplies for people with diabetes and some preventive services for people who may be at risk.
In addition, Part B covers outpatient training to help people learn how to manage their diabetes. Because the condition involves a higher risk of glaucoma and foot disorders, Part B coverage includes an annual glaucoma test and a bi-annual foot exam.
Deductibles, copays, and coinsurance apply to all the above benefits. If someone has Medigap, which is Medicare supplement insurance, it can help with these costs.
An individual enrolled in Original Medicare is eligible for Medicare Part D, which is prescription drug coverage. Part D covers supplies needed for inhaling or injecting insulin.
Medicare Advantage
If a person has Medicare Advantage (Part C), the alternative to Original Medicare, it covers at least the services and supplies that Part B provides. Many Advantage plans also have prescription drug coverage, and some may include additional benefits relating to diabetes.
There are
Type 1 diabetes
When a person has type 1 diabetes it means their body makes little to no insulin. This is because their immune system destroys the cells in the pancreas that make the hormone.
People
Type 2 diabetes
In type 2 diabetes, an individual’s pancreas either does not make enough insulin or their body does not use it well. Most people develop type 2 diabetes in adulthood and later in life.
People who have overweight or obesity and are physically inactive
Gestational diabetes
Gestational diabetes develops in some people during pregnancy. However, it usually goes away after the birth of the baby. However, an individual with the condition may have a higher risk of developing type 2 diabetes later in life.
Medicare resources
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The MDPP provides training in diet, exercise, and weight management for people who may be at risk of diabetes. In addition to lessons, it involves coaching and follow-up sessions.
The program is free for those who meet the criteria for it.