People who are at risk of developing diabetes may benefit from enrolling in the Medicare Diabetes Prevention Program (MDPP).
This article discusses the MDPP content and eligibility requirements, as well as Medicare’s coverage of diabetes. It then defines diabetes, looks at the different types of the disease, and examines the possible complications.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The MDDP is a series of sessions that train a person on how to engage in lifestyle practices that may reduce the likelihood of developing type 2 diabetes. It is a 2-year program that involves three parts. The Centers for Disease Control and Prevention (CDC) have approved the MDPP curriculum.
In the first part, an instructor conducts 16 core sessions in a group setting over a 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 and third parts include:
- half a year of monthly follow-up sessions to help maintain healthy habits
- an additional year of ongoing maintenance sessions if a person meets the program’s weight loss and attendance goals
Someone may enroll in MDPP if they meet certain conditions. Two of the requirements are a BMI of 25 or higher and a blood test result that indicates prediabetes.
A diagnoses of prediabetes means a person’s blood sugar is high, but not high enough to receive a diabetes diagnosis.
A person who has original Medicare and meets the eligibility requirements may enroll in MDDP at no charge. Original Medicare comprises Part A, hospitalization insurance, and Part B, medical insurance.
Medicare Part B covers MDPP once in a person’s lifetime if all the following conditions 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.
In addition, a person must have one of the following blood test results within a year of the first core session:
Both original Medicare and Medicare Advantage provide coverage.
Part B covers services and supplies for someone with diabetes. It also includes some preventive services for a person who may be at risk.
In addition, Part B covers outpatient training to help people learn how to manage their diabetes. Because the disease 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 to get Medicare Part D, which is prescription drug coverage. Part D covers supplies needed for inhaling or injecting insulin.
If a person has Medicare Advantage, 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.
Diabetes is a disease that involves high blood glucose, also called blood sugar. Blood glucose is a person’s main source of energy, and it comes from food and beverages. Insulin, a hormone made in the pancreas, enables glucose to get from the bloodstream into the cells, where it is used for energy.
Sometimes, a person’s pancreas does not make enough insulin, or it may stop making the hormone. Or, in some people, the pancreas makes enough insulin, but the body does not use it well. In these cases, glucose stays in the blood and does not enter the cells.
High blood glucose produces symptoms such as fatigue and increased thirst. Over time, it can cause health problems in many parts of the body.
Diabetes is common in the United States. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 9.4% of individuals had the disease in 2015.
Diabetes has three primary types: type 1, type 2, and gestational.
Type 1 diabetes
When a person has type 1 diabetes it means their body does not have insulin. This is because their immune system destroys the cells in the pancreas that make the hormone.
Doctors usually diagnose type 1 diabetes in children and young adults. Someone with this type of diabetes needs to take insulin every day.
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. While the disease most often develops in middle-age or those aged 65 and older, it can occur in people of any age.
Diabetes can run in families, and in some racial/ethnic groups including
African Americans, Asian Americans, and Hispanics/Latinos.
Approximately 90–95% of diabetes cases in U.S. adults are type 2.
Gestational diabetes develops in some women during pregnancy, but it usually disappears after the birth of the baby. However, a woman with the condition has a higher risk of developing type 2 diabetes later in life.
Over time, high blood glucose can cause serious health problems, such as:
The MDPP provides training in diet, exercise, and weight management for people who may be at risk of diabetes. Aside from lessons, it involves coaching and follow-up sessions.
It is 100% free for a person with original Medicare.
Because diabetes is a serious disease that can cause many complications, any program that may help prevent it merits consideration.