Medicare Diabetes Prevention Program: Free Coverage for Prediabetes

Prediabetes affects more than 88 million American adults -- and approximately 1 in 3 Medicare beneficiaries. Without intervention, up to 30% of people with prediabetes will develop Type 2 diabetes within 5 years. Medicare covers a proven, structured lifestyle change program that can prevent or significantly delay the onset of Type 2 diabetes -- at no cost to qualifying beneficiaries.

The Medicare Diabetes Prevention Program (MDPP) is a structured lifestyle change program based on the landmark Diabetes Prevention Program clinical trial, which showed that modest lifestyle changes -- losing 5-7% of body weight and increasing physical activity -- reduced the risk of developing Type 2 diabetes by 58% (71% in adults over 60).

The program is delivered by CDC-recognized organizations and consists of:

Year 1 (Core sessions):

• 16 weekly sessions (first 6 months)
• 6 monthly sessions (months 7-12)
• Focus: healthy eating, physical activity, stress management, problem-solving, and behavior change

Year 2 (Ongoing maintenance):

• Monthly sessions for beneficiaries who achieve the 5% weight loss goal
• Continued support for maintaining lifestyle changes

To qualify for Medicare's MDPP coverage, you must:

1. Be enrolled in Medicare Part B
2. Have a body mass index (BMI) of 25 or higher (23 or higher if Asian American)
3. Have a blood test result in the prediabetes range within the past 12 months:
   • Hemoglobin A1c: 5.7%-6.4%
   • Fasting plasma glucose: 110-125 mg/dL
   • 2-hour plasma glucose (after 75g glucose load): 140-199 mg/dL
4. Not have been previously diagnosed with Type 1 or Type 2 diabetes
5. Not have end-stage renal disease

The MDPP is covered at no cost -- no copay, no coinsurance, no deductible -- when provided by a Medicare-enrolled MDPP supplier.

MDPP sessions are offered by CDC-recognized organizations including:

• YMCAs
• Community health centers
• Hospitals and health systems
• Online/virtual providers (expanded significantly during and after COVID-19)

To find a provider: Ask your doctor for a referral, or search the CDC's DPP provider directory at cdc.gov/diabetes/prevention/find-a-program.

Virtual options: Many MDPP programs are now available online -- making participation easier for seniors with transportation challenges or mobility limitations.

If you haven't been tested for prediabetes, Medicare covers diabetes screening tests at no cost for beneficiaries at risk. Risk factors include:

• Overweight or obesity
• High blood pressure
• High cholesterol
• Family history of diabetes
• History of gestational diabetes
• Physical inactivity
• Age 45 or older

Ask your doctor about prediabetes screening at your next visit or Annual Wellness Visit.

The MDPP is one of Medicare's most valuable preventive benefits -- a free, proven program that can prevent a serious chronic disease. If you have prediabetes, taking advantage of this benefit could be one of the most important health decisions you make.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.