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Insurance and Medicare Coverage

Does my insurance cover diabetes education?

Commercial insurance plans

It is in your best interest to determine how your health insurance pays prior to service. Most insurances do cover for both DSMT and MNT. You may have benefits you are not aware of and are not using. It is recommended that you check with your insurance provider to verify that you have this benefit. You are responsible to for any co-pays and/or deductibles.

Traditional Medicare coverage

Diabetes self-management services
  • Medicare covers both diabetes self-management training and diabetes medical nutrition therapy services under Medicare Part B.
  • Medicare will cover a total of 10 hours of initial DSMT diabetes self-management training.
  • Your initial diabetes training must be completed no more than 12 months from the date you start.
  • Medicare will cover 2 hours of follow-up diabetes self-management training annually
Medical Nutrition Therapy
  • Covered at no cost to you. No copay or deductible diabetes nutrition services
  • Medicare covers 3 hours of nutrition counseling to be completed within the initial calendar years
  • Two hours of follow up nutrition services is covered every year following your initial year of training.

Medical Advantage Plans

If you have a Medicare Advantage Plan or other Medicare Supplemental Plan diabetes self-management training and medical nutritional therapy covered, but first check with your plan.

Medicare-covered diabetes self-management training

Medicare covers diabetes self-management training. This service is covered under Medicare Part B. If you have a Medicare Advantage Plan or other Medicare Supplemental Plan, diabetes self-management training should be covered, but first check with your plan.

For diabetes self-management training to be covered you must have a written order from your doctor. The St. Mary Medical Center Diabetes Education Program is certified by the American Diabetes Association.

  • Medicare will cover a total of 10 hours of initial diabetes self-management training.
  • Your initial diabetes training must be completed no more than 12 months from the time you start.
  • One hour of the 10 hours of training can be given as a one-on-one meeting.
  • The other 9 hours are given in a group class.
  • Medicare will also cover an initial 3 hours of individualized nutrition counseling to be completed within a calendar year.
  • You are also covered for 2 hours of follow-up training each year, and 2 hours of nutrition counseling each year following your initial year of training.
  • The 2 hours of follow-up training can be with a group or you may have a one-on- one meeting.

Important: Your doctor may prescribe 10 hours of individual training if you are blind or deaf, have language limitations, or if no group classes have been available within 2 months of your doctor's order.