1. Difficulty with Technology

• Struggling with using standard technology devices.  You may hear: “I have a smartphone, but I don’t know how to use it.”
• Forgetting passwords and needing assistance to log into devices or accounts.
• Not knowing how to download an app on their smartphone or tablet.

2. Device Confusion 

• Difficulty understanding how devices connect and share information.
• Confusing diabetes devices. You may hear: “My CGM gives me my insulin.”
• Thinking the insulin pump is “autopilot” and does not enter carbohydrates or meal announcements into the pump.

3. Fear Factor

• Communicating fear of diabetes technology. You may hear: “I just don’t trust those things!” and “What if it gives me the wrong dose?” 
• Avoiding eye contact or changing the subject when discussing diabetes technology.
• Expressing worry of becoming overwhelmed with diabetes technology.

4. Technology Comprehension

• Not recognizing or acting on the device alerts and alarms. 
• Difficulty interpreting glucose graphs and trend arrows.
• Struggling with troubleshooting the diabetes tech device. You may hear: “I just don’t know why this thing beeps all the time.”

5. Avoidance of Technology

• Shutting down discussion of diabetes technology. You may hear: “I’m too old to learn how to use that.”
• Unwilling to learn how to use the device because the spouse or another family member manages it on their behalf. 
• Frequently rescheduling or not coming to training sessions to learn how to use the diabetes device

Can MNT Be Covered By Insurance?

Coverage for MNT in the United States varies considerably by payer type. Federally, for Medicare Part B, MNT is covered when a beneficiary has diabetes, non-dialysis chronic kidney disease (stage 3-5), or has had a kidney transplant within the past 36 months. A Medicare-enrolled RDN can schedule and bill for services after obtaining a physician signed (MD or DO) referral, at this time mid-level providers currently do not qualify to sign MNT referrals for Medicare benefit. Medicare provides for up to three hours of MNT in the first year of referral and up to two hours in each subsequent year (with allowance for additional hours if deemed medically necessary). ³ As of January 2025, RDNs can also bill for Direct Training Caregiver Services, which means they can provide education and training to unpaid caregivers who help with tasks like meal preparation and wound care. ²

Medicaid programs are financed by both the state and federal governments, but each state can determine its own coverage and
reimbursement for specific services. State Medicaid programs exhibit significant variability in their coverage and reimbursement rates for MNT services. A recent mapping project by the Academy of Nutrition and Dietetics 4 found that while 37 states recognize MNT billing codes, in only 26 states can RDNs enroll as Medicaid providers (one additional state for pediatric services only), and in only 23 states can RDNs bill independently (others can bill incident-to services). Coverage for MNT services also varies, with some limiting depending on the diagnosis to other states providing reimbursement for a broad range of preventive and medical nutrition therapy. 5

Commercial insurance plans also vary widely in their benefit structure, with some limiting coverage while others extending beyond Medicare-covered diabetes and CKD to also include pre-diabetes, obesity, malnutrition, cardiovascular disease (including hypertension and dyslipidemia), cancer, eating disorders, gastrointestinal conditions, and more.

Although some plans have expanded their coverage, it is not universal and understanding coverage requires knowing an individual’s insurance plan benefits, the RDN network status, diagnosis and referral requirements, the number of covered visits/hours/units, medical or preventive benefit coverage, and, if applicable, telehealth eligibility. Benefits can change annually, and reimbursement rates can also vary widely depending on the state and payer.

When the Affordable Care Act was implemented in 2010 it help provide premium subsidies and increased coverage of preventive and chronic disease services. This led to an increase in MNT coverage expectation and waived share-of-cost for individuals receiving MNT. However, in practice, coverage remains patchwork, with substantial variability in approved diagnoses, covered hours, cost-sharing requirements, and provider networks across plans.