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Medicare Will Pay to Help You Prevent Diabetes

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If you get diabetes and your doctor prescribes medications, Medicare will kick in its allotted share of the drug costs. No prob!

But if you want to prevent that debilitating disease—if you’re one of the 86 million Americans with prediabetes, the above-normal blood sugar condition that greatly increases your risk of getting type 2 diabetes—you’ve been on your own.

Sure, your doctor will tell you to lose weight, eat better, get some exercise. But until now Medicare wouldn’t pay for the kind of proven lifestyle program that might actually save your life—or at least make it a lot healthier.

That’s about to change.

Medicare is poised to cover the YMCA’s Diabetes Prevention Program, which is simple yet remarkably effective. Participants meet in a group with a coach weekly for 16 sessions, followed by monthly sessions for the rest of the year and, if desired, into the second year. The goal is to beat down the obstacles that stop the participants from eating better, exercising 150 minutes a week and losing weight.

The program’s results are impressive. On average, participants lose 5.5% of their body weight—enough to cut their risk of developing diabetes by more than 50%. Medicare estimates the cost of covering the program would be up to $450 for the first year and up to an additional $180 for the second.

Is that a good investment for Medicare? To find out, they studied the costs that would likely occur over 15 months for this group of people if they weren’t enrolled.

The estimated savings were just as impressive as the health benefits—$2,650 per person. Savings may be even greater in the following years.

That was enough for Medicare to announce that it would start covering the Y program in 2017—with details by this summer. While private insurance companies are not compelled to follow Medicare’s lead in deciding what treatments to cover, they often do.

What if you don’t want to wait? You could join the program now and pay for it—it’s available in about 200 YMCAs across the country, with more on the way. Also, check with your insurance company—some cover clinical versions of the program, which are equally effective, although often more expensive. To learn more about individual clinical programs in your area, start with the Centers for Disease Control’s National Diabetes Prevention Program.

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Source: Report titled “Certification of Medicare Diabetes Prevention Program” from the Office of the Actuary, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services, Baltimore. Date: April 14, 2016 Publication: Bottom Line Health