Diabetes Awareness and Treatment Through Medicare

Published 06/25/2020

According to the Mayo Clinic, more than half of Americans who are more than 60 years of age have diabetes. In the future, it is expected that number will grow dramatically, as well as the costs to treat this disease. Another source of information, the Centers for Disease Control and Prevention (CDC), says that 30.3 million people currently have diabetes, and of them, 7.2 million are undiagnosed.

All of these statistics are important. If you have not been diagnosed with diabetes, there is a free Medicare preventive service you should take advantage of. You could be one of the silent 7.2 million.

Here are the details:

If you have been diagnosed with prediabetes, you can have a diabetes screening once every six months. Or, you can have one screening every 12 months if you were previously tested but not diagnosed with prediabetes or if you were never tested before.

Some risk factors your provider will look for when recommending the screening:

  • High glucose (sugar) levels
  • High blood pressure, high cholesterol and high triglyceride levels
  • Obesity

Other reasons you may be eligible for this screening (you must meet two of these items):

You have a family history of diabetes or you have a history of diabetes during pregnancy (gestational diabetes). Another qualifying factor is if you delivered a baby that weighed more than nine pounds. Additional considerations include your age (65 years of age or older) or are overweight.

Medicare also has a model program called the Medicare Diabetes Prevention Program, or MDPP. This program seeks to help beneficiaries with an indication of prediabetes to  prevent the onset of Type 2 diabetes. This is done through classroom-setting learning about changing your diet, increasing your physical activity and learning strategies to help you lose weight. 

Here are the requirements to take part in this program:

  • You are enrolled in Medicare Part B/Railroad Medicare
  • You do not have End-Stage Renal Disease (ESRD)
  • You have a Body Mass Index of 25 or more (23 or more if you are Asian)
  • You have not been diagnosed with Type 1 or Type 2 diabetes (not including gestational diabetes), and
  • Have at least one of the following within 12 months of the first classroom learning session:

1. An A1C value between 5.7 and 6.4% or

2. Two-hour plasma glucose of 140-199 mg, or

3. Have a fasting glucose level of 110-125 mg

The MDPP includes 16 basic sessions provided over six months to participants in a group setting. After completing the basic sessions, you are eligible for follow-up sessions each month for six months. If you are successful in meeting specific weight loss and attendance goals, you are eligible for maintenance sessions for 12 more months.

If you are interested in this service, talk to your provider to see if you qualify.

If you have questions about your Railroad Medicare coverage, you can call our Beneficiary Contact Center toll-free at 800-833-4455, Monday through Friday, from 8:30 a.m. until 7 p.m. ET. We offer a TTY/TDD line at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Representatives are available.

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