The Medicare Diabetes Prevention Program is for people at risk for type 2 diabetes. This free program helps people who qualify follow a healthy lifestyle and lower their chance of getting the disease.
According to the Centers for Disease Control and Prevention (CDC), about
Medicare, together with other health organizations like the Centers for Disease Control and Prevention (CDC), offers a program called the Medicare Diabetes Prevention Program (MDPP). It’s designed to help people at risk for diabetes prevent it.
If you qualify, you can join the program for free. You’ll get advice, support, and the tools you need to lead a healthier lifestyle and reduce your chance of getting diabetes.
The MDPP is designed to help Medicare beneficiaries who have prediabetes symptoms develop healthy habits to prevent type 2 diabetes. The Centers for Medicare and Medicaid Services (CMS) oversees the program on a federal level.
Since 2018, the MDPP has been offered to people who qualify for Medicare. It was developed in response to the growing number of Americans with diabetes because the condition is both chronic and expensive. In 2022 alone, the United States spent around $205 billion on medical care related to diabetes in individuals ages 65 and over, and Medicare covered most of this expense.
To help beneficiaries and to save money, a pilot program called the Diabetes Prevention Program (DPP) was developed. It allowed Medicare to spend money on diabetes prevention, with the hope that this would mean less money would be spent later on treating diabetes.
The DPP focused on CDC guidance for lowering the risk of diabetes in people with prediabetes. Methods included teaching people enrolled in the DPP how to:
- change their diet
- increase their physical activity
- make overall healthier lifestyle choices
The original program ran in
In 2017, the program was expanded into the current MDPP.
Medicare Part B coverage
Medicare Part B is medical insurance. Together with Medicare Part A (hospital insurance), it makes up what’s known as Original Medicare. Part B covers services like doctor’s visits, outpatient services, and preventive care.
Preventive care is completely covered for people enrolled in Medicare. This means you won’t need to pay 20% of these costs, like you would for most Part B services.
Preventive care includes a variety of programs and services to help you stay healthy, including:
- wellness visits
- smoking cessation
- vaccines
- cancer screenings
- mental health screenings
Like all preventive services, the MDPP is free as long as you meet the eligibility requirements (discussed below) and use an approved provider.
You’re only eligible for the MDPP once during your lifetime; Medicare won’t pay for it again.
Medicare Advantage coverage
Medicare Advantage, also known as Medicare Part C, is an option that allows you to buy a plan from a private insurance company that contracts with Medicare. All Medicare Advantage plans are required to offer the same coverage as original Medicare, but some plans also offer additional coverage, including free preventive services.
That said, some plans have a network, and you’ll need to stay in network for full coverage. If the MDPP location you’re interested in isn’t in network, you might need to pay some or all of the costs out of pocket.
If it’s the only MDPP location in your area, your plan might still cover it fully. If you have a local in-network option, though, the out-of-network location won’t be covered. You can call your plan provider directly for coverage details.
Just like with Part B, you can get covered for the MDPP only once.
The services you get from the MDPP will be the same no matter what part of Medicare you’re using.
This 2-year program is divided into three phases. During each phase, you’ll have set goals, and you’ll get support to help you meet them.
Phase 1: Core sessions
Phase 1 lasts for the first 6 months that you’re enrolled in the MDPP. During this stage, you’ll have 16 group sessions. Each will happen once a week for about an hour.
An MDPP coach will lead your sessions. You’ll learn tips for healthy eating, fitness, and weight loss. The coach will also measure your weight at each session to track your progress.
Phase 2: Core maintenance sessions
During months 7 through 12, you’ll be in phase 2. You’ll attend at least six sessions during this phase, though your program may offer more. You’ll get ongoing help with developing healthy habits, and your weight will continue to be tracked.
To move past phase 2, you’ll need to show that you’re making progress in the program. Generally, this means attending at least one session in months 10 through 12 and showing weight loss of at least 5 percent.
If you’re not making progress, Medicare won’t pay for you to move on to the next phase.
Phase 3: Ongoing maintenance sessions
Phase 3 is the final stage of the program and lasts one year. This year is divided into four periods of three months each, called intervals.
You’ll need to attend at least two sessions in each period and continue to meet weight loss goals to continue in the program. You’ll have sessions at least once a month, and your coach will continue to help you as you adjust to your new diet and lifestyle.
What if I miss a session?Medicare allows providers to offer makeup sessions but doesn’t require it. This means that it’s up to your provider.
Your MDPP provider should let you know when you sign up what your options are if you miss a session. Some providers may allow you to join another group on a different night, while others might offer one-on-one or even virtual sessions.
To start the MDPP, you need to be enrolled in Medicare Part B or Part C. You’ll then have to meet some additional criteria. To enroll, you can’t have been:
- diagnosed with diabetes unless it was gestational diabetes
- diagnosed with end stage renal disease (ESRD)
- enrolled in the MDPP before
If you meet these requirements, you’ll need to show you have signs of prediabetes. These include a body mass index (BMI) of more than 25 (or more than 23 for participants who identify as Asian). Your BMI will be calculated from your weight at your first sessions.
You’ll also need lab work that shows you have prediabetes. You can use one of three results to qualify:
- hemoglobin A1c test with results of 5.7% to 6.4%
- fasting plasma glucose test with results of 110 to 125 milligrams per deciliter (mg/dL)
- oral glucose tolerance test with results of 140 to 199 mg/dL
Your results will need to be from the last 12 months, and you must have your doctor’s verification.
One of your first steps for enrollment should be talking with your doctor about your prediabetes signs. Your doctor can verify your current BMI and order the lab work you’ll need before joining a program.
You can then search for programs in your area using this map and then enroll online
Make sure any program you use is Medicare-approved. If you have a Medicare Advantage (Part C) plan, make sure the program is in-network.
You shouldn’t receive a bill for these services. If you do, you can contact Medicare right away by calling 800-Medicare (800-633-4227).
How can I get the most from the program?
It’s important to be ready for the changes that will come with the MDPP. You might need to make changes to your lifestyle, including:
- cooking more meals at home
- eating less sugar, fat, and carbohydrates
- drinking less soda and other sugary drinks
- eating more lean meats and vegetables
- getting more exercise and activity
You don’t have to make all of these changes at once. Small changes over time can make a big difference. Plus, your coach can help you by providing tools like recipes, tips, and plans.
It can also be helpful to have your spouse, a family member, or a friend commit to some of these changes with you, even if they’re not in the MDPP. For example, having someone to take a daily walk with or cook with can keep you motivated between sessions.
Since 2024, CMS will reimburse an MDPP supplier for each core session or core maintenance session attended by an MDPP beneficiary, with a maximum of 22 sessions allowed within a 12-month period. This is an increase from the previously approved five sessions and is designed to encourage participation.
Additionally, CMS has removed performance-based payments for attendance but still uses weight loss as a measure of success. They have also kept the diabetes risk-reduction payment system in place, which rewards plans that help participants achieve 5% or 9% weight loss goals.
What else is covered for diabetes care under Medicare?
The MDPP is meant to prevent diabetes. If you already have diabetes or develop it later, you can get coverage for a range of care needs, including screenings, supplies, eye exams, and more.
If you have Medicare Part D (prescription drug coverage), you can also get coverage for supplies like needles and syringes, medications, and insulin.
Any Medicare Advantage plan will cover all the same services as Part B and may include some of the items covered by Part D as well.
Who supplies the Medicare diabetes prevention program?
An MDPP supplier is a Medicare-enrolled organization that can charge for providing MDPP services to eligible recipients. This is often a hospital or a clinic, but it can vary by geographic area. You can find the suppliers in your area by searching your zip code on CMS.gov.
What is the Preventing Diabetes in the Medicare Act?
If passed, the Preventing Diabetes in Medicare Act (H.R. 3124/S.1299) will allow registered dietitians to receive reimbursements from Medicare for nutrition therapy to people at risk of prediabetes, in addition to the other categories already covered. This Senate bill has been read twice and referred to the Committee on Finance in 2023.
If you have prediabetes, the MDPP can help you prevent type 2 diabetes.
Remember that the MDPP is free if you qualify, but you can only participate once. You also need to have indicators of prediabetes to qualify. The program lasts for two years.