In the announcement, timed to the sixth anniversary of the Affordable Care Act's passage, officials said that Medicare could one day help cover prevention services for 86 million Americans with a condition known as pre-diabetes. These people have elevated levels of glucose in their blood, although not high enough for a diagnosis of Type 2 diabetes. That debilitating disease, which causes heart and kidney problems, blindness and strokes, is one of the leading causes of death in the United States.
The five-year, $11.8 million pilot, conducted at YMCAs nationwide, demonstrated that older people could lose weight through lifestyle counseling and regular meetings that encourage healthful eating habits and exercise — an improvement that helps stave off diabetes. On average, the more than 7,700 participants lost about 5 percent of their body weight.
Sylvia M. Burwell, secretary of the Department of Health and Human Services, said prevention programs of this kind “help people live longer, fuller lives and save money across the [health care] system.” She estimated that expanding the initiative within Medicare would save $2,650 over 15 months per beneficiary, compared with current payment models. That would be more than enough to cover its costs, she said.
HHS has not determined when Medicare might begin paying for such services or how it would afford them, though officials said an initial explanation could come this summer. It is not clear when all Medicare beneficiaries would be covered.
Edna Waller of New Castle, Del., who participated in the pilot program, said she lost 25 pounds and three dress sizes because of the changes she made after participating in 16 weekly meetings with a lifestyle coach and monthly sessions for a year after that. She said she has kept the weight off and has passed on the information to her husband, who accompanies her on exercise walks.
The 69-year-old said her husband already has diabetes, but the couple is saving money because he requires less medication as a result of the exercise program. Waller said she was “well on my way to getting” diabetes but “learned things about nutrition and exercise” that helped her lose the weight.
“At this age, it's not easy,” she said.