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Find Coverage for a Diabetes Education Program

Studies show that people with diabetes who have had diabetes self-management education and support (DSMES) manage their diabetes better, lead healthier lives, and experience less diabetes distress. Here's how to find a program in your area and how to get coverage.

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Talk to the health care provider who manages your diabetes.

Whether your primary care provider or endocrinologist helps you care for your diabetes, it's unlikely they have time to help you learn about diabetes and lifestyle changes, answer your questions about eating plans and carb counts, help you set behavior-change goals, and offer support to you and your family members. To increase your knowledge and pick up practical pointers, ask your provider to refer you to an accredited diabetes education program or a certified diabetes educator (CDE), registered dietitian (RD), or registered dietitian nutritionist (RDN) for medical nutrition therapy (MNT). It is your right to ask to be referred for this service.  

Diabetes self-management education and support (DSMES) obtained in an accredited program is covered by Medicare Part B and many private health insurance plans. Two associations currently accredit programs: the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA). MNT is another service that you may be able to get in addition to DSMES. Dietitians who provide MNT must be registered by the Academy of Nutrition and Dietetics. Most diabetes education programs are for people with type 2 diabetes.

The best way to find accredited programs in your area is to look at the lists on the AADE and ADA websites. Find the one closest to you and ask you primary care provider for a referral. If you can't find one, ask your health care provider for a reference.

Find self-management education and support programs in your area:

Programs accredited by the American Association of Diabetes Educators 

Programs recognized by the American Diabetes Association 

Check out your health plan coverage.

Medicare Part B covers some DSMES: up to 10 hours from an AADE- or ADA-accredited program within the first year of diagnosis when prescribed by a provider. Typically this education is provided in a group class. There are exceptions. If a person is blind or deaf or has language limitations, or if no group classes are available within two months of a provider's order, or the person lives in a rural area, then the 10 hours can be provided through individual training. Typically, one of the 10 hours is on an individual basis.

A primary care provider can subsequently prescribe up to two hours of additional DSMES each year. A person can also be referred for up to three hours of Medical Nutrition Therapy (MNT) in the first year of diagnosis and two hours a year in subsequent years as long as these services are not provided on the same day.

On your health plan's website, look for the phrase "benefit coverage," then "diabetes case management," a topic that covers both diabetes supplies and education. Search for terms such as “diabetes education,” “self-management training,” and “diabetes education classes.”

Get answers to these questions:

• Does my policy cover DSMES and/or MNT?

• Is there a limit to the number of hours that my health plan covers?

• Are there preferred DSMES programs or MNT providers?

Expect to get answers, get an offer to investigate your questions and get back to you, or get transferred to someone who can help. If you're told that these services are not covered, ask to consult with someone else to confirm the information.

Medicare's guidelines tend to guide what other payers do. Still, the coverage offered by employers' group plans, private health insurers, and other programs may differ. Confirm the specifics about coverage on your health plan's website or by calling the toll-free number on your card. Or if you are employed, talk to your benefits administrator directly.

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