New Diabetes Prevention Program Covered under Medicare Part B

Nearly half (48 percent) of U.S. adults ages 65 and older have pre-diabetes, meaning their blood sugar levels are high enough to put them at risk for developing type 2 diabetes. Diabetes is associated with a host of health complications, including stroke, kidney disease, blindness, and even amputations of the legs and feet.

What’s more, diabetes is costly. In 2013, diabetes cost the U.S. health system over $100 billion—more than the cost for many other chronic conditions like heart disease, low back and neck pain, and depression. The prevalence of pre-diabetes among older adults coupled with the staggering costs associated with diabetes heightens the importance of prevention among Medicare beneficiaries.

Fortunately, the federal government has stepped in with a proven solution. Starting next month, Medicare will begin paying qualified providers to deliver the Medicare Diabetes Prevention Program (MDPP), an evidence-based set of services aimed at preventing type 2 diabetes among Medicare beneficiaries with prediabetes. The program improves health and also has been shown to save Medicare an estimated $2,650 in health care costs per enrollee, more than the cost of the program.

Beneficiaries who qualify for the MDPP must attend at least 16 sessions in the first six months with a trained coach who guides them through a core curriculum approved by the Centers for Disease Control and Prevention, followed by six months of monthly maintenance sessions. The year-long curriculum teaches healthy eating habits, tips for losing weight and keeping it off, and offers strategies to increase exercise. Medicare will cover an additional year of maintenance sessions if beneficiaries achieve weight loss and attendance goals.

The program will be free to Medicare beneficiaries. Medicare beneficiaries don’t need a referral from a health provider in order to participate in the MDPP. However, clinicians can play an important role by identifying Medicare beneficiaries who have prediabetes and making them aware of the MDPP. This is especially important because only 14 percent of adults ages 65 and older with prediabetes are even aware that they have the condition.

The MDPP is a great step forward for public health. With Medicare enrollment expected to increase over 40 percent by 2030, efforts to prevent diabetes among this population will be more important than ever. By helping older adults make lifestyle changes to prevent diabetes, the benefit can help millions live longer, healthier, more productive lives.