Health Insurance to cover the National Diabetes Prevention Program (National DPP)
Private Health Insurance
Many insurance companies offer coverage for participating in a National Diabetes Prevention Program. In California, the following health plans are participating payers:
- Anthem Blue Cross
- Blue Shield of California
- Cigna
- Healthnet
- Kaiser Permanente
- LA Care
- Molina Healthcare
- Providence Health Plan
- UnitedHealthCare
This list may not be inclusive of all plans. Please contact your insurance provider to verify coverage for the National Diabetes Prevention Program.
Medi-Cal
Effective January 1, 2019, the National DPP is a Medi-Cal covered benefit. Medi-Cal Providers can recommend participation in the National DPP to eligible full-scope Medi-Cal beneficiaries who meet the eligibility requirements (please see About National Diabetes Prevention Program). If you are interested in participating in Medi-Cal's DPP, please inform your health care provider who can make sure you are eligible for the program and put you in touch with a DPP provider.
If you are a member of a Managed Care Plan (e.g., Health Net, L.A. Care, etc.), you can call your Managed Care Plan's member services number for more information. You can find this number on the back of your benefits card or by using this directory.
| Plan Name | Phone |
|---|---|
| Health Net Community Solutions, Inc. |
(800) 675-6110 TTY/TDD (800) 431-0964 |
| L. A. Care Health Plan |
(888) 839-9909 TTY/TDD (866) 522-2731 |
| Specialty Name | Phone |
| AltaMed (PACE) | (877) 462-2582 TTY/TDD (800) 889-7862 |
| Brandman Centers for Senior Care | (855) 774-8444 TTY/TDD (818) 774-3194 |
| Positive Healthcare | (800) 263-0067 TTY/TDD (800) 735-2929 |
| SCAN Health Plan | (877) 452-5898 TTY/TDD (800) 735-2929 |
Medicare Diabetes Prevention Program (MDPP)
Beginning April 1, 2018, eligible beneficiaries have coverage of MDPP services with no cost-sharing through Medicare-enrolled MDPP suppliers.1 If you have any questions about your Medicare coverage for the National Diabetes Prevention Program, please call 1-800-MEDICARE. Medicare Advantage plans are also required to offer the benefit to their members.2
Medicare eligible beneficiaries are those who:
- Are enrolled in Medicare Part B
- Have a body mass index (BMI) of at least 25 (≥23 if Asian) - check your BMI here
- Meet 1 of the following 3 blood test requirements within 12 months of the first core session:
Result A1C Test Glucose Tolerance Test Fasting Blood Sugar Test Prediabetes 5.7% - 6.4% 140 - 199 mg/dL 100 - 125 mg/dL - Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
- Do not have end-stage renal disease (ESRD)
Resources
- Medicare Diabetes Prevention Program (MDPP) - Expanded Model Fact Sheet https://innovation.cms.gov/Files/x/MDPP_Overview_Fact_Sheet.pdf
- National Diabetes Prevention Program Coverage Toolkit - Participating Payers https://coveragetoolkit.org/participating-payers/
