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Medicare to Cover Diabetes Prevention Program!

Updated: 8/14/21 5:00 amPublished: 4/8/16

"Monumental news for the 51% of American seniors living with prediabetes."

In a meaningful first for preventive care in the US, Medicare will now reimburse the Diabetes Prevention Program (DPP), a proven educational program for those with prediabetes. Experts determined that the DPP not only is successful in decreasing participants’ risk for developing diabetes (through an average ~5% body weight loss), but also saves Medicare an average of $2,650 per person enrolled in the program for 15 months– more than enough to cover the cost of the program (which can cost up to $430 out of pocket, without insurance). The proposal still needs to go through a public comment period, but it is likely to be adopted. Click here to find the full list of CDC-approved programs near you.

The DPP is a CDC-approved program that provides participants with a combination of intense individual counseling and motivational support on effective diet, exercise, and behavior modification. It has proven effective in helping seniors lose an average of 5% of their body weight, enough to reduce their risk of diabetes by an average of 71%. Of the 86 million Americans with prediabetes, at least 22 million are people over the age of 65 (which translates to over 50% of seniors having prediabetes!). Research from the CDC demonstrates that, without intervention, up to one third of those with prediabetes will end up developing type 2 diabetes within five years.

Who Will Qualify for DPP Reimbursement?

According to the official certification from CMS, Medicare beneficiaries will have to meet the following criteria in order to qualify for DPP:

  • Body Mass Index (BMI) of 25 or greater
  • A1c of 5.7% to 6.4% OR
  • Impaired fasting glucose (fasting plasma glucose of 110 – 125 mg/dl) OR
  • Impaired glucose tolerance (two-hour plasma glucose after Glucose Tolerance Test of 140 mg/dl – 199 mg/dl)
  • No previous diagnosis of diabetes
  • No life-threatening conditions or mobility issues that would prohibit them from participating in the program

The YMCA is currently the largest deliverer of in-person DPP interventions nationally; click here to find one near you or a loved one, and click here to find the full list of CDC-approved programs. Digital CDC-recognized DPP interventions include Omada Health, Noom Health, and DPS Health and offer a convenient platform for people to take advantage of this program online. With Medicare paying for seniors to participate in these programs if the proposal gets approved, there is hope that there will be far more providers of the DPP, improving access to the service.

As Omada CEO Sean Duffy put it in a press release and blog post, “By elevating evidence-based diabetes prevention as the reimbursed standard of care, [CMS] has acknowledged the urgency of addressing what has become a national epidemic… this is monumental news for the 51% of American seniors... living with prediabetes." - NK

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