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Medicare Behavior Change Model Targets Type 2 Diabetes Prevention

Diabetes Prevention Program (MDPP) provides Medicare beneficiaries with intervention tools to prevent the onset of diabetes.

Reviewed by: Michael Howard, Licensed Insurance Agent. Written by: Andrew Hall.

Man reviews his health wellness score on his laptop.

Key Takeaways

  • The Medicare Diabetes Prevention Program (MDPP) helps at-risk Medicare customers learn to improve their diets, increase their physical activity, and control their weight.

  • MDPP uses education and accountability with classroom lessons and regularly scheduled maintenance sessions

  • Diabetes is a costly problem for the American healthcare system, but programs like MDPP can have a significant impact on preventing it.

What is the Medicare Diabetes Prevention Program (MDPP)?

The MDPP program is a learning curriculum designed for training Medicare beneficiaries how to change physical, mental, and dietary habits that contribute to the onset of type 2 diabetes. The Centers for Disease Control and Prevention (CDC) partner with Medicare to provide guidelines for living a healthier life and reducing the risk of type 2 diabetes. MDPP approaches prevention two ways: (1) Core Services, (2) Ongoing Maintenance Services.

How does the MDPP program work?

The MDPP program provides the same services for beneficiaries with Original Medicare or Medicare Advantage. The program is divided into phases, each follows CDC guidance to set goals and support you on your health journey.

Phase 1

This six-month course has 16 core sessions. You will have a 60-minute session each week until you complete the course. During phase one, a MDPP certified health coach will teach you about healthy diet, exercise, and weight loss.

Phase 2

During this five-month phase, you will be required to attend at least six sessions. You can attend more than six sessions, but you must meet the minimum requirement to move to phase three. Phase two provides ongoing coaching and guidance as you work toward your minimum weight loss goal of five percent. If you don’t make progress toward your goal in phase two, Medicare won’t cover the cost to advance on to phase three.

Phase 3

The final phase of the program is split into four periods, each lasting three months. You are required to attend at least two sessions in each period. Each session is designed to help beneficiaries continue adjusting to healthier diets and exercise with the goal of developing a healthier lifestyle.

What is MDPP coverage for Medicare Beneficiaries?

Medicare beneficiaries, including Medicare Advantage, who meet MDPP eligibility requirements are entitled to receive only one set of MDPP services in their lifetime. Medicare Advantage (MA) plans may offer extended coverage for diabetes prevention. MA plans may also offer virtual services for prevention and prediabetes that do not qualify as MDPP. services. You do not pay copayments or coinsurance for MDPP services.

Who is Eligible for MDPP?

There are many diabetes prevention programs available, MDPP is only for Medicare enrollees. The program is covered by Medicare Part B, which includes Original Medicare and Medicare Advantage plans.


How do I know if I should enroll in the MDPP?

To enroll in the program, you need to meet all of the following requirements:

  • You must have Medicare Part B coverage
  • Within one year of the first session, you must have at least one result from three possible blood tests:
    • Hemoglobin A1c test with a value of 5.7 to 6.4%
    • Fasting plasma glucose test with a value of 110 to 125 mg/dl
    • Oral glucose tolerance test with a value of 140 to 199 mg/dl
  • A body mass index (BMI) of at least 25 or 23 if self-identified as Asian.
  • No history of type 1 or type 2 diabetes, with the exception of gestational diabetes.
  • No End Stage Renal Disease (ESRD).
  • Not received MDPP services previously.

Do I need a referral to sign up for MDPP?

You do not need a referral from your doctor, but you will need to show that you’ve hit all of your requirements, including specific blood tests. If you have your test results and qualify for the MDPP, you can sign up without a doctor’s referral. Working with your PCP during the program may help improve your outcomes.

How do I enroll in MDPP?

It’s recommended that your first step is to discuss your diabetes risk with your doctor. If you meet the requirements and are at risk of developing diabetes, your provider can help you enroll in MDPP. If not, visit the Centers for Medicare & Medicaid Services (CMS) website for information on MDPP. [1]

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