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Medicare Diabetes Prevention Program (MDPP) a Vital Benefit for Beneficiaries

In the third article of the Comagine Health series spotlighting the National Diabetes Prevention Program (National DPP) in observance of National Diabetes Month, we'll focus on the Medicare Diabetes Prevention Program (MDPP) model.

Did you know that type 2 diabetes affects more than 25% of Americans aged 65 or older? Or that nearly half of American adults aged 65 or older have prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes?

Without weight loss or routine moderate physical activity, many of those with prediabetes will develop type 2 diabetes with a few years. 

To address this, in 2018, the Centers for Medicare & Medicaid Services (CMS) implemented the MDPP model. This model allows eligible Medicare beneficiaries to access evidence-based lifestyle change programs focused on preventing diabetes. The goal of the model is to lower the rate of progression to type 2 diabetes, improve health and reduce spending. 

The MDPP is an important part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC). Via program suppliers, Medicare beneficiaries have access to structured sessions with a coach who uses a CDC-approved curriculum to provide training in dietary changes, increased physical activity and weight loss strategies. This once-per-lifetime Medicare benefit covers 12 months of sessions with a lifestyle coach and an additional 12 months of ongoing support if a participant meets specific weight loss and attendance goals. 

To be eligible for the program, Medicare beneficiaries must:

  • Have Medicare Part B coverage through Original Medicare (Fee-for-Service) or a Medicare Advantage (MA) plan
  • Have a body mass index (BMI) of at least 25, or at least 23 if self-identified as Asian
  • Meet one of the following three blood test requirements within the 12 months of the first core session: 
    1. A hemoglobin A1c test with a value between 5.7 and 6.4%
    2. A fasting plasma glucose of 110-125 mg/dL
    3. A two-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
  • Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
  • Not have end-stage renal disease (ESRD)
  • Not received MDPP services previously

There are no out-of-pocket costs for participants enrolled in Medicare Part B. 

Clinicians play a crucial role in helping beneficiaries understand their risk of diabetes and treatment options. They can also support patients to obtain the needed blood tests to know their prediabetes risk and refer them with MDPP services.

This November, we invite you to connect with the MDPP supplier in your area. They are your partner in supporting patients along their lifestyle change journey of delaying or preventing the development of type 2 diabetes. To find a Medicare DPP in your region, visit CMS’ map of MDPP suppliers furnishing MDPP services

Interested in becoming a Medicare DPP supplier? More information is available here.

If you have questions or would like further assistance, please reach out to us at DPPHelpDesk@comagine.org.

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