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Medicare covers diabetes prevention program

Written by Diane Archer

More than 29 million Americans, including almost 12 million older adults, have type 2 diabetes. That’s almost 10 percent of adults in the United States and more than 25 percent of adults over 65. Diabetes is the seventh leading cause of death in the nation. The Centers for Medicare and Medicaid Services has approved Medicare coverage of a proven diabetes prevention program. The benefit is designed to help educate people on best practices for avoiding type 2 diabetes.

More than one in three people with Medicare–23 million–have pre-diabetes, according to the Centers for Disease Control (CDC). Most people are unaware they are pre-diabetic, putting them at higher risk of diabetes, heart disease and stroke. They have high blood-sugar levels. More than seven million of them are projected to develop diabetes in the next five years without changes in their levels of activity and eating habits. Moreover, diabetes can cause blindness, amputation and kidney disease.

Through behavior modification, diabetes can be prevented or delayed. Medicare’s diabetes prevention program relies on trained coaches to help adults likely to be diagnosed with type 2 diabetes with lifestyle modifications. The program focuses on exercise and healthy eating as well as behavior changes to help people lose weight. Medicare offers it for free as a one-time benefit for eligible individuals.

All people with pre-diabetes blood-sugar levels are eligible for this Medicare benefit, so long as they have never been diagnosed with diabetes. You must also have a body-mass index of 25 or higher, or 23 or higher if you are Asian.

The diabetes prevention program benefit involves 16 intensive small group sessions over six months. It also involves up to twice monthly meetings for another six months to help ensure maintenance of healthy behaviors. During this time, you must track your weight and keep a record of what you eat and your physical activity.  The program aims to help participants get at least two and a half hours of exercise each week and to lose five percent of their body weight. For participants who meet the weight-loss goal and attend classes, Medicare pays for a second year of classes to reinforce key principles.

The CDC rolled out the program four years ago, and it is now offered by several hundred organizations throughout the country, including some YMCAs and senior centers. A study of the diabetes prevention program showed that it reduced the odds of adults getting diabetes by 58 percent. And, it reduced the odds of adults over 60 getting diabetes by 71 percent.

To date, tens of thousands of Americans have participated in the program, just a small percentage of the millions who could benefit. The cost of $400-$500 a participant is prohibitive for many.

Now that Medicare covers the cost for people with traditional Medicare and Medicare Advantage plans, the hope is that millions more will participate. Medicare should save money on everyone who enrolls. The health care savings for each enrollee who avoids getting diabetes is projected to be $7,300. Medicare also covers diabetes screening tests, self-management training (DSMT), medical nutrition therapy (MNT), glaucoma screening and diabetic supplies.

Note: Because community groups are new Medicare contractors, it may take a little time for a program to be available in your community.

Here’s more from Just Care:

Take this risk test to see if you have pre-diabetes.

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