new Medicare prediabetes benefit

… and why it signifies a sweeping change in health care

A welcome surprise was announced in early 2018 for those diagnosed as prediabetic in the West Phoenix metro area… and it signifies a fundamental change in how insurance providers view health care benefits. 

Medicare introduced a new benefit that pays for the Medicare Diabetes Prevention Program to prevent or delay the onset of type two diabetes.

Why does this matter? One out of four adults over 65 have prediabetes, and many of them are completely unaware of it.

Not only does it significantly impact health and mortality—including risk of heart disease,stroke and Alzheimer’s disease—but it triples the costs of health care… an expense that directly impacts deductibles, copays, prescription medications and other expenses.

The cost is now covered by Medicare and many other health insurance providers for those who meet certain criteria for the program, although copays or deductibles for specific health insurance plans may apply.

“This program is the first preventative program ever offered by Medicare. It signifies a fundamental change in the healthcare system from treating disease to preventing it. It’s tremendously exciting to see this kind of paradigm shift begin,” says Rene Kridler, practice manager at Sun Health’s Center for Health & Wellbeing.

Sun Health was the first organization in Arizona approved to offer the Medicare-reimbursed program and provides it to residents in Surprise and Sun City, Arizona.

While Medicare’s approval of the program as a paid benefit is new, Sun Health has been a CDC-approved instructor for the program in the West Valley since 2016 as part of its community health initiatives.

What this means for you

Each insurance provider may have different requirements and approval processes, so it’s important to discuss eligibility and benefit details for the program with your insurance provider to avoid any misunderstandings. Benefits and costs may vary depending on the individual health plan.

Two-thirds of those with prediabetes haven’t been formally diagnosed. Click here to learn about silent symptoms you should be aware of and here to take a brief quiz.

Medicare has specific criteria in place to qualify for the program. There must be no previous diagnosis of diabetes, an individual must have a body mass index (BMI) of 25 or greater, and no life-threatening conditions or mobility issues that prevent a participant from attending all classes in the program.

It’s also critical that participants be able to commit to the entire program, which is lengthy. Because it is designed to help participants make positive lifestyle changes for nutrition, exercise and weight management, completing the entire program helps establish these changes long-term. This fits with the program goal of lifelong prevention of diabetes.

Because the program spans an average of twelve months from beginning to completion, joining the program is a significant commitment to improving health.

Curriculum for the Medicare Diabetes Prevention Program is determined by the CDC (Centers for Disease Control) and largely identical across all providers teaching the program. (Click here to learn more.) Because it’s an extended program, choosing a provider near your residence is important.

What’s included in the class?

Because type two diabetes is a preventable condition avoided by the right education and motivation, the class tackles nutrition and diet to help attendees understand how their daily food choices influence progression of diabetes, and smart dietary changes that can permanently banish the threat.

Tips for eating healthy, monitoring blood sugar, medication interactions, reducing risks and other topics are covered in detail.

It also includes problem-solving strategies for fitness and weight management, since a moderate weight loss of just 5-7 percent can reduce the risk of developing diabetes by 71 percent. Becoming less sedentary and incorporating activity into daily living is an important component of fighting diabetes.

Most insurance providers will require an order from the physician for the class.

Sun Health currently offers the class in Surprise, Arizona at the Center for Health & Wellbeing and Sun City, Arizona at Banner Boswell Medical Center. This is a multi-part class; click here for upcoming start dates. Please call 623-832-WELL (9355) to register or learn more.

Walk-ins are not accepted and registration closes several days prior to the beginning of the first class. Please register early to ensure availability. 

Diabetes Prevention Program - new Medicare prediabetes benefit


(Originally published March 30, 2018; last updated Jan. 6, 2019.)

You may also like

Comments are closed.