Congress Quietly Changes Medicare Coverage Rules Affecting Millions

Older Americans count on Medicare to provide coverage for essential health services. While there are some coverage gaps and out-of-pocket expenses that typically make getting a supplementary policy necessary, Medicare forms the backbone of coverage for most older Americans. Close to 70 million people are enrolled in Medicare, almost all of whom are seniors 65 and over.

And those who rely on this coverage received good news recently, as Congress quietly changed the rules in early February to offer important health resources for a common senior health issue.

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Medicare rule change makes coverage accessible for millions

In early February, lawmakers signed a large budget package that ended a government shutdown and funded the government for the fiscal year.

The budget package contained many provisions, including one that directly impacts Medicare beneficiaries. Specifically, as part of the budget package, Congress passed a law called the PREVENT Diabetes Act. This little-known healthcare law reauthorized a program that allows digital health companies to participate in the Medicare Diabetes Prevention Program (MDPP) until the end of 2029.

Virtual suppliers have been able to offer services within this program since the COVID-19 pandemic, but they have had only temporary authorization to provide virtual classes on diabetes prevention. This created uncertainty and limited the availability of digital options. With the rule change, virtual providers now have confidence they'll be treated as covered suppliers, at least until 2029.

The legislation also lifted a requirement that providers must have the ability to deliver educational services in person before they'd be allowed to offer remote service, and permitted patients to be able to record their weight remotely.

This should lead to more virtual offerings becoming and remaining available to enable retirees to attend synchronous virtual classes on diabetes prevention, as well as to watch recorded educational sessions on their own schedule.

How does this Medicare rule change help retirees?

In 2010, the Centers for Disease Control and Prevention started a National Diabetes Prevention Program, as the rate of type 2 diabetes was rising. The CDC approved certain courses on lifestyle interventions that could help prevent or control type 2 diabetes. The Medicare Diabetes Prevention Program built upon the CDC's work, launching in April 2018 with providers who taught in-person classes to Medicare Part B beneficiaries at community sites.

During the COVID-19 pandemic, Medicare agreed to provide coverage for diabetes education providers to offer virtual classes. However, enrollment in Medicare's program has remained limited, with only around 4,848 Medicare beneficiaries enrolling in courses, in large part because of the absence of in-person class locations in many congressional districts. With Congress now making it easier for companies to offer digital services, many more Medicare beneficiaries could take advantage.

In fact, over half a million people participate in the CDC's programs, and many more could benefit from Medicare's educational support, given that around 32% of Medicare beneficiaries report ever having been diagnosed with diabetes. While these courses are focused on people with pre-diabetes, there are still millions of people who could potentially benefit from convenient, free education that they don't have to pay for out of their retirement plans.

Those who are on Medicare and are worried about diabetes risks should consider taking advantage of this rule change to explore options for taking a class in their own home that could help them prevent or manage this serious condition.

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