The Medicare Diabetes Prevention Program is a year-long lifestyle change benefit covered in full by Medicare Part B for beneficiaries with prediabetes. You pay nothing if you qualify. The program runs up to 22 group sessions across 12 months, led by a trained coach, and focuses on eating habits, physical activity, and weight loss. As of February 2026, the old once-per-lifetime enrollment limit is gone, so people who tried the program before can enroll again if they still meet the medical criteria.
Who Qualifies
You need to be enrolled in Medicare Part B and have blood test results from the past 12 months showing prediabetes-level readings.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage Any one of these qualifies:
- Hemoglobin A1c between 5.7% and 6.4%
- Fasting plasma glucose between 110 and 125 mg/dL
- Two-hour oral glucose tolerance test between 140 and 199 mg/dL
You also need a body mass index of at least 25 on the date of your first session. If you identify as Asian, the threshold is 23, reflecting research that Asian populations face elevated diabetes risk at lower BMI levels.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage
Two conditions disqualify you: a prior diagnosis of type 1 or type 2 diabetes, and end-stage renal disease. A history of gestational diabetes does not count against you.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage
You do not need a doctor’s referral. Medicare lets you enroll directly with an MDPP supplier as long as your qualifying lab results are documented by a healthcare provider.2Centers for Medicare & Medicaid Services. Referring Patients to the Medicare Diabetes Prevention Program Talking with your doctor is still useful for interpreting your blood work and deciding on timing.
What It Costs You
Nothing. Medicare Part B covers the whole program, and CMS waives both the Part B deductible and the usual 20% coinsurance.3Medicare.gov. Medicare Diabetes Prevention Program Your supplier bills Medicare directly and cannot charge you fees.
How the Year Is Structured
The program runs 12 months in two phases. During the first six months, you attend up to 16 core sessions spaced at least a week apart. These group sessions follow a CDC-approved curriculum covering eating habits, activity, and behavior change.4Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program FFS Billing and Payment Fact Sheet for CY 2026
In months 7 through 12, you move into a maintenance phase with up to 6 sessions spaced at least a month apart. These reinforce what you built earlier. The maximum across both phases is 22 sessions.4Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program FFS Billing and Payment Fact Sheet for CY 2026
Weight Goals
The program’s benchmark is 5% weight loss from your starting weight, with a second milestone at 9%. Your coach weighs you at every session, and during the maintenance phase Medicare tracks whether you keep at least 5% off baseline.4Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program FFS Billing and Payment Fact Sheet for CY 2026 Your ability to attend sessions is not tied to hitting these numbers. You can finish all 22 sessions regardless of how much weight you lose.
Missed Sessions
If you miss a session, your supplier can offer a make-up covering the same topic. The rules allow one make-up per week and one on the same day as a regular session. Virtual make-ups are available on request, capped at four over the full 12 months, with no more than two during maintenance.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage If something keeps you away longer, you can pause and resume within the 12-month window.5Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Expanded Model FAQs
In-Person, Live Virtual, and Online Options
Sessions can be delivered three ways: in person at a community site, through distance learning with a live coach and participants on phone or video, or through a fully online format you work through on your own schedule. From January 1, 2026, through December 31, 2029, suppliers offering online delivery are not required to also maintain in-person capacity, which widens access for rural beneficiaries and people with mobility challenges.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage
Online programs require live, two-way interaction with a human coach each week you engage with content, by email, text, or in-app messaging. Chatbots and AI replies don’t count.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage You submit your weight on the date you complete each online session.
One restriction matters when you’re choosing a supplier: your entire set of sessions has to be delivered in a single format. You cannot mix online with in-person or live virtual. If you enroll in an online program, every session is online. If you enroll in an in-person or distance-learning program, those stay synchronous throughout.
You Can Enroll Again If You’ve Done It Before
Until early 2026, Medicare treated this as a one-shot benefit. If you completed the program or dropped out, you could not enroll again. That changed with the Consolidated Appropriations Act, 2026, signed on February 3, 2026, which removed the once-per-lifetime limit.5Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Expanded Model FAQs If you were previously told you had used your one-time benefit, that restriction no longer applies. You still need to meet the lab and BMI criteria at the time of your new enrollment.
If You Have Medicare Advantage
Medicare Advantage plans must cover MDPP because they must provide all Part B services. The eligibility rules and session structure are the same.6Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Beneficiary Eligibility Fact Sheet Your plan may limit you to in-network suppliers, which can narrow your choices compared to Original Medicare.
Some plans add supplemental diabetes prevention benefits on top of MDPP, like extended coverage or fully virtual wellness programs. Those extras are fine, but they aren’t substitutes. If your plan steers you to an alternative program instead of a CDC-recognized MDPP supplier, that alternative does not satisfy the Part B benefit.7Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Medicare Advantage Fact Sheet
If You’re Diagnosed with Diabetes During the Program
A diabetes diagnosis mid-program does not end your eligibility. You can keep attending your remaining sessions. CMS recommends seeing your primary care provider to develop a treatment plan alongside the MDPP.5Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Expanded Model FAQs
A diagnosis also opens up additional Medicare benefits, including Diabetes Self-Management Training and Medical Nutrition Therapy. You can receive those at the same time as your MDPP sessions. If your supplier is also enrolled to provide DSMT or MNT, they can bill for both concurrently.5Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program MDPP Expanded Model FAQs
Finding a Supplier and Signing Up
The quickest route is the search tool on Medicare.gov, where you enter a zip code to see participating organizations. CMS also maintains an interactive map of active program sites nationally. With the online expansion in place, you may find suppliers operating entirely online that accept participants regardless of location.
Before your first session, confirm the organization is enrolled with CMS as an MDPP supplier. Some organizations run CDC-recognized diabetes prevention programs that are not enrolled to bill Medicare, and those won’t be covered. You’ll need to show proof of Part B enrollment and qualifying blood test results.1eCFR. 42 CFR 410.79 – Medicare Diabetes Prevention Program Expanded Model Conditions of Coverage The supplier keeps the records and handles billing with Medicare directly. Once eligibility is verified, they schedule you into the next available group.