The best way to manage diabetes is to learn how to change your lifestyle. Taking pills or insulin is not enough to prevent or decrease your risk of health problems from diabetes.
Diet, exercise levels, stress, and other factors may all affect blood sugar levels. The more you learn how these factors affect your health, the better you can control them. Then you can be healthier.
Medicare Part B covers most of the costs for you to learn:
- How to manage your diabetes, called diabetes self-management training
- What you should eat, called diet and nutrition services
Self-management training teaches you how to control your diabetes. You learn how to monitor your blood sugar, diet, exercise, and insulin.
You will learn how to take better care of yourself and how to change your lifestyle. If you can control your diabetes, you will feel better. You may also have fewer medical problems and fewer hospital visits.
You will receive a personal assessment in the first session. This way, your teachers can meet your specific needs. You will also have group sessions with others like you who have diabetes. With the group, you will learn about:
- How good blood sugar control can help you
- How poor blood sugar control can hurt you
- Ways you can maintain and improve your blood sugar control
- Your diet and nutrition
- Why exercise is important to your health
- How to take your drugs properly
- Using results of your blood sugar tests to better control your diabetes
- Ways to prevent, recognize, and treat health problems from diabetes
Medicare covers 10 hours of training within a continuous 12-month period. You may get more hours it if you are blind, hearing impaired, or have language limitations, or if there are no group classes within 2 months of your doctor's order.
You get 2 hours of follow-up training each year after that. One of those hours can be one-on-one training. You must finish your first training no more than 12 months after you start it.
Do I qualify?
You can get this training if you met at least 1 of these conditions in the last 12 months:
- You were diagnosed with diabetes
- You began taking diabetes drugs, or changed from pills or liquid diabetes drugs to insulin
- You have diabetes and recently got on Medicare
- You are at risk for health problems from diabetes. You could be at risk if:
- You have problems controlling your blood sugar, or
- You have recently had to go to an emergency room because of your diabetes, or
- You have been in the hospital overnight recently because of your diabetes, or
- You get a diagnosis of eye disease related to diabetes, or
- You have certain other problems.
How do I get this training?
Medicare rules say your doctor must prescribe it for you.
You must get this training from a special diabetes self-management education program. It must be certified by the American Diabetes Association or the Indian Health Service. The training must be part of a plan of care that your doctor or a qualified practitioner prepares. Ask your doctor how to get it.
If you live in a rural area, you can get diabetes self-management training in a Federally Qualified Health Center, or FQHC. To find one near you, visit U.S. Health Resources and Services Administration.
What will it cost?
First, you must meet your Medicare Part B deductible. Then you pay 20% of the cost Medicare approves for this training.
Medical nutrition therapy
Medical nutrition therapy gives you advice on what to eat. Medicare Part B covers this. It also covers certain related services for people on Medicare who have diabetes.
When you have diabetes, you must eat well to manage your blood sugar properly. A registered dietitian or nutrition professional can give you:
- An initial opinion on what you eat and your lifestyle
- Advice on what foods to eat and how to follow a personal diabetic meal plan
- How to manage certain lifestyle factors that affect your diet, such as exercise and stress
- Follow-up visits to help you manage your diet
Do I qualify?
You qualify if your fasting blood sugar has certain levels. Your doctor must prescribe these services to you. You must provide a doctor's prescription each year for Medicare to pay for the service.
How often can I get these services?
Medicare covers 3 hours of therapy in the first year you receive the services. You get 2 hours of follow-up services each year after that. You meet face-to-face with a professional provider, such as a registered dietician or a nutrition professional.
If your doctor decides there is a change in your medical condition, you may be able to get more hours.
What will it cost?
You pay nothing for cost of this service if you have Original Medicare and you see a doctor who “accepts assignment.” Doctors who accept assignment agree to accept the amount that Medicare will pay for a visit or service (called the Medicare-approved amount) as payment in full.
If you are in a Medicare Advantage plan, the plan cannot charge you for this service as long as you see an “in-network” provider, meaning a doctor who has an agreement to treat people who belong to the plan. If you use a provider outside your plan's network, it may cost you money.