I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
Answered by 15 licensed agents
Preventive care is not done on the bases of your medicare but on the quality of care from your doctor. A good doctor will provide good care and education to prevent progression of illness. Depending on your insurance and dietary needs set by your physiscian, you can utilize benefits like nutrition health as well as gym memberships to support a good healthy habit which are typically included with your coverage.
Its always a tough when you hear about any diagnosis from a Health Care professional regarding Diabetes. If you watch the news at all, you know that any Diabetes related health condition is serious and effects a large part of our population. Medicare provides several "Preventive Services'" that come at low or no Out of Pockets costs. Medicare Diabetes Prevention Program (MDPP) is a comprehensive One Time health behavior change program is available to help you prevent Type II diabetes. Common services like Diabetes Screening and monitoring, Medical Nutrition, foot exams and Hemoglobin A1C, Glaucoma Screenings as well as "Welcome to Medicare" preventive visits are design to address your diagnosis and prevent it from getting worse! Your Medicare agent can educate you on what is available to you! If you are new to Medicare you will love it!
Medicare covers the Pre-diabetes program once in your lifetime. But, you must meet all 12 conditions to be covered. Part B will pay for the full costs associated with this treatment, should you qualify. This is a behavioral program only.
This program is a once-per-lifetime behavior modification course that includes 16 sessions over 6 months, focusing on diet, exercise, and weight management. The MDPP is covered by Medicare Part B and Medicare Advantage plans
The Medicare Diabetes Prevention Program begins with up to 16 weekly group sessions over a 6-month period. You can choose to attend sessions in person, virtually, or both. This is provided as a one-time benefit. Nutrition services (professional) are not provided.
Medicare covers services to help prevent prediabetes from progressing to type 2 diabetes, including screenings, the Medicare Diabetes Prevention Program (MDPP), and diabetes self-management training.
Diabetes Screenings: Medicare Part B covers up to two diabetes screenings per year if you are at risk for diabetes or have prediabetes. These screenings can include blood glucose tests, and they are covered at 100% of the Medicare-approved amount when received from a participating provider.
Medicare Diabetes Prevention Program (MDPP): This program is a once-per-lifetime health behavior change program that helps you prevent type 2 diabetes. It involves group sessions with a trained coach, focusing on diet, exercise, weight management, and support.
Diabetes Self-Management Training: Medicare Part B covers diabetes self-management training, which helps you understand and manage your diabetes.
In summary, Medicare provides preventive services to help you manage your prediabetes and lower your risk of developing type 2 diabetes, including screenings, a comprehensive lifestyle program, and educational resources.
Medicare covers insulin and a variety of antidiabetic drugs. Original Medicare (parts A and B) and Medicare Advantage (part C) cover insulin administered via a pump and certain diabetes supplies.
Medicare prescription drug coverage provides comprehensive coverage for diabetes medications. Reach out to me or an agent in your area for more information. Also, Medicare.gov is a great resource.
Medicare has a couple ways to help support you through this. Medicare covers annual wellness visits to monitor your progression. Medicare may provide further counseling to discuss lifestyle and behavior change options. Some Medicare supplement plans and many Medicare Advantage plans have a silver sneakers benefit that will cover gym membership costs at participating gyms to help you manage your overall health.
All types of diabetic screenings/educational trainings are typically falling under the title of “preventive care”. All preventive care is typically free of charge, but there are quantity and some limitations. That’s something you would want to talk to an agent or broker about to get more detailed information on that’s because it’s also impacted by what plan you have and what carrier you have and where you live, along with what type of screening are they wanting to do. All of these things have to be taken into consideration. Mostly speaking, all preventive care is typically zero charge to the client.
Keep in mind if you have a Medicare advantage, you will have to have a prior authorization approved before you can go get that done and with original Medicare and Medicare supplements you have no prior authorizations.
If you’ve been told you have prediabetes, Medicare covers some preventive services you may be able to take advantage of to help you avoid developing type 2 diabetes. One of them is the Medicare Diabetes Prevention Program (MDPP). This free, year-long program includes group classes on healthy eating, exercise, and lifestyle changes, with support for up to two years if you qualify. Medicare also covers free diabetes screenings, nutrition counseling, and weight loss support if you meet certain criteria.
Under Original Medicare (Part A and B), a person has access to Diabetes Screening and Diabetic Counseling that may include diabetes prevention and education. Some Medicare Supplements (Medi-Gap) and Medicare Advantage Plans offer "0" cost gym memberships included, which may help prevent full diabetes.