Managing the health issues surrounding diabetes can be challenging… so can managing the insurance issues. The following information is designed to help you sort through your coverage.
Medicare Coverage of Diabetes Self Management Training (DSMT)
- Medicare provides coverage of DSMT services only if the treating provider makes a referral for need.
- Medicare will cover initial training up to ten hours in 12 calendar months if no prior education has been paid for by Medicare.
- Medicare will cover one hour of initial individual training but the other hours should be in a group setting or class unless a barrier is present.
- After receiving initial training (ten hours in 12 months), Medicare will cover up to two hours of individual or group training each following calendar year.
- Medicare provides coverage of Medical Nutrition Therapy (MNT) for three hours the initial year for those with diabetes.
- Medicare covers up to two hours each subsequent year for MNT and diabetes.
Private Insurance Coverage for Diabetes Education (DSMT)
- Diabetes education is typically covered by private insurance carriers. However some plans may vary and coverage may be subject to deductibles. We recommend you check with your insurance carrier if you are uncertain of your coverage.
- It is important to note that carriers of ThedaCare insurance and their families do receive FREE diabetes education through our department.
Medicare Coverage of Nutrition Therapy (non-diabetes)
- Medicare provides coverage of Medical Nutrition Therapy (MNT) for three hours the initial year and two hours each subsequent year for those with chronic kidney disease (CKD).
- For diagnoses other than diabetes and CKD, coverage for nutrition should be verified as it is changing and is likely subject to the secondary insurance coverage.
Private Insurance Coverage for Nutrition Therapy (non-diabetes)
- Coverage of education for a variety of nutrition topics (pre-diabetes, cholesterol, weight management, eating disorders, failure to thrive, etc.) varies by insurance company and individual plan. We recommend you contact your insurance company for verification of coverage and any deductibles or co-pays that may apply.