Original Medicare (Parts A & B): Medicare Diabetes Prevention Program (MDPP)

Medicare and Medicare Advantage cover the Medicare Diabetes Prevention Program (MDPP) once in the recipient's lifetime if all the following conditions apply:

• Your loved one has Medicare Part B or a Medicare Advantage plan

• Within 12 months of the first session, your loved one has one or more of these:

  • Hemoglobin A1c test results between 5.7 and 6.4%

  • Fasting plasma glucose of 110-125mg/dL

  • 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerant test)

• Your loved one has a body mass index (BMI) of 25 or more (BMI of 23 or more if Asian)

• There is no history of type 1 or type 2 diabetes

• Your loved one has never been diagnosed with End-Stage Renal Disease (ESRD)

• Your loved one has never participated in the MDPP.

The Diabetes Prevention Program study conducted by the National Institutes of Health (NIH) found that lifestyle changes resulting in modest weight loss sharply reduced the development of type 2 diabetes in people at high risk for the disease (people with “prediabetes”) and this resulted in the development of the Medicare Diabetes Prevention Program (MDPP).

The MDPP is a proven, structured health behavior change program to help prevent type 2 diabetes. It provides practical training in long-term dietary change, increased physical activity, and problem-solving strategies for overcoming challenges to sustain weight loss and a healthy lifestyle.

In 2022, CMS expanded the MDPP model. The program begins with 6 months of weekly group sessions. These sessions consist of:

• Training to make realistic, lasting behavior changes around diet and exercise

• Tips on how to get more exercise

• Strategies to control weight

• A specially trained coach to maintain motivation

• Support from people with similar goals and challenges

Once the weekly sessions are completed, 6 monthly follow-up sessions are provided to help maintain healthy habits.

If your loved one started the MDPP in 2021 or earlier, they'll get 12 more monthly sessions if they meet specific weight loss goals. The primary goal is at least 5% weight loss.

These services are offered by approved MDPP suppliers. These suppliers may be traditional healthcare providers or entities such as community centers or faith-based organizations.

Learn more about the MDPP program and/or Find an approved MDPP supplier.