It’s Your Benefit: Medicare and Diabetes Education

You don't have to deal with diabetes alone. A Medicare benefit covers group education classes

Our society is aging rapidly. In 2010 40 million people were over the age of 65. This accounts for 13 percent of the population, and that number is projected to rise another 18 million by the year 2020. The risk of developing diabetes increases dramatically with age, so that as our population ages, more and more people will be diagnosed with diabetes.  Currently,  one in four  older adults has diabetes.

Now that is worrisome; diabetes is a chronic disease that drains physical, mental and economic resources.  This is why everyone with diabetes should take advantage of all the resources available to them to learn how to control the disease and make life with diabetes more manageable.

One of the great benefits of growing older is your eligibility for Medicare.  Prior to turning 65 your access to diabetes education may be circumscribed by state regulations, the dictates of private insurance plans and your ability to privately pay for your diabetes education.  All of that changes once you receive federal benefits under Medicare. Diabetes self-management training/education, abbreviated DSMT (E), and medical nutrition therapy (MNT) are mandated by Medicare.

These are two separate benefits: DSMT(E) covers the topic areas outlined in the National Standards of DSME.  The topics cover such things as checking your blood glucose, taking your medications and finding ways to healthfully cope with the stress of having a chronic disease. It also includes a section on nutrition basics for diabetes.   Medicare allows 10 hours of education as a one-time benefit in the first year you use the benefit.  The benefit starts from the date you start the education, so if you start in Novem ber you have until the next November to finish the 10 hours.  Nine of these ten hours must be in a group situation unless you have a condition or disability—for example, hearing loss—that prevents you from attending a class. The entity providing DSMT/E must be a recognized provider with Medicare (they must have completed the requirements and be accepted by Medicare).

In each following year you are entitled to 2 more hours of education.  Depending on your needs, and capacity of the facility where you receive services, you may see a variety of health care workers such as a nurse, dietitian, social worker and or exercise physiologist.

MNT is a complementary benefit.  You must be counseled by a registered dietitian or nutrition professional who is a Medicare provider and your physician must write a referral for you to receive the service.  Instead of general information about healthy diet principals for people with diabetes, you should receive an individualized nutrition care plan and be monitored for changes in your diet and laboratory values.  You are entitled to 3 hours of MNT for the first year. MNT years are calendar years so if you start in September you have until December 31 of that year to complete your 3 hours.  In each additional year you are entitled to  2 more hours.   If you require additional education, for example because you have developed a complication of your diabetes, your physician has to approve it.

Both DSMT/E and MNT have been shown to be effective in helping people manage their diabetes care. It is a shame more people either don’t know about this benefit or don’t take advantage of it.  It is your benefit, don’t let it slip away.

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