Medicare Diabetes Prevention Program
Medicare Part B (Medical Insurance) covers the Medicare Diabetes Prevention Program, if you’re eligible.
Description
The Medicare Diabetes Prevention Program is a health behavior change program to help you prevent type 2 diabetes.
The program has 16 sessions. You'll do one session per week within a 6-month period. In these sessions, you’ll get:
- A specially trained coach to help keep you motivated
- Training to make realistic, lasting behavior changes around diet and exercise
- Tips for getting more exercise
- Strategies to control your weight
- Support from people with similar goals and challenges (if you choose to participate in-person or through distance learning)
After the first 6 months, you get 6 follow-up sessions (one per month for 6 months) to help you maintain healthy habits.
Who's eligible
You’re at risk for developing type 2 diabetes, and all of these conditions apply to you:
- Within 12 months before attending your first core session, you have either a:
- Hemoglobin A1c test result between 5.7% and 6.4%
- Fasting plasma glucose of 110-125mg/dL
- 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerant test)
- You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian).
- You've never been diagnosed with type 1 or type 2 diabetes or End-Stage Renal Disease (ESRD).
Provider requirements
- You can get these services from an approved Medicare Diabetes Prevention Program supplier. These suppliers may be traditional health care providers or organizations like community centers or faith-based organizations.
- If you're in a Medicare Advantage Plan , you may have to go to an in-network provider to get these services. Contact your plan for more information.
Facility
You can participate in the program through any of these class formats:
- Distance learning (you attend live sessions online)
- Self-paced (you complete sessions online, any time)
- In person
To find a supplier online or in person, use the “Find providers” search.
Costs
You pay nothing if you qualify.
How often
There's no limit to the number of times you can participate in the Medicare Diabetes Prevention Program.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service