Centers for Medicaid and Medicare New regulations Februrary 26, 2026

A temporary ban has been placed on the enrollment of DME providers as of February 26, 2026.

WASHINGTON – The Center for Medicare & Medicaid Services (CMS) will implement a six-month nationwide moratorium on the Medicare enrollment of DMEPOS supplier medical supply companies, according to a notice in the Federal Register.

What suppliers are impacted?

The moratorium will affect the following supplier types:

  • Medical supply company

  • Medical supply company with orthotics personnel

  • Medical supply company with pedorthic personnel

  • Medical supply company with prosthetics personnel

  • Medical supply company with prosthetic and orthotic personnel

  • Medical supply company with registered pharmacist

  • Medical supply company with respiratory therapist

What’s behind CMS’s decision?

In a press release, CMS says the moratorium will allow it to explore additional safeguards to further mitigate what it calls longstanding instances of fraud, waste and abuse perpetrated by certain DMEPOS companies. It applies to all applications for initial enrollment and changes in majority ownership for medical supply companies.

In the notice, the agency provided the following:

  • The seven types of medical supply companies listed were all in the top 20 out of over 80 DMEPOS supplier specialty types when looking at the highest percentage of DMEPOS suppliers of a specific specialty type that were revoked at least once since 2023.

  • Five of the seven types of medical supply companies were in the top 10 when reviewing the highest percentage of DMEPOS suppliers with a payment suspension since 2023.

  • Six of the seven types of medical supply companies were in the top 10 when examining the highest percentages of law enforcement referrals since 2023.

  • All seven types were in the top 15 when looking at the highest percentage of BIU complaints for each DMEPOS supplier type since 2023.

Additional measures

The agency also plans to publish information on suppliers whose participation in the Medicare program has been revoked, including their National Provider Identifier (NPI) and the reason for the revocation. This additional transparency, it says, will allow patients and payers, including private insurers, to understand which providers have been subject to such administrative enforcement action by the government.

Will Medicaid follow suit?

CMS says it is allowing each state to decide whether some form of a DME moratorium is appropriate for their respective Medicaid and CHIP programs.

“Each state has greater expertise and experience with their pool of DME provider types, including the requirements for each type of DME provider, than CMS,” it states. “Nevertheless, CMS encourages each state to, as appropriate, implement a DME provider moratorium tailored to the specifics of their beneficiary population as well as any geographic considerations. Additionally, CMS is offering every state and territory the opportunity to consult with CMS on the prospect of implementing a Medicaid- or CHIP-based (or both) DME moratorium in their jurisdictions.”

Latest effort to crack down on health care fraud, CMS says

The agency says these new efforts build on the agency stopping more than $1.5 billion in suspected fraudulent billing in this area this year. It also highlighted recent efforts to address what it says are abusive pricing practices for skin substitutes, which helped to lower premiums by $11 per month for Medicare beneficiaries by reducing overall Part B spending.

The six-month moratorium is part of a larger announcement by the Trump administration on its latest major crackdown on health care fraud, it says.” (https://www.hmenews.com/article/cms-announces-temporary-moratorium-on-new-medicare-enrollment-for-certain-dmepos-suppliers)

There’s been a lot of confusion online lately, so let’s clear things up. Yes, people who already use insulin pumps can still get their pump supplies. Most established DME (Durable Medical Equipment) providers are operating as usual. If you’ve already got a go-to supplier, you’re probably in the clear—expect business as usual.

If you’re new to using a pump, as long as your prescription goes through an existing provider, you should be fine, too.

The real change is this: the new rules are meant to keep new DME suppliers from entering the market, and to prevent existing DME companies from merging. In plain English, if your current supplier is barely hanging on, don’t expect a rescue or a buyout anytime soon. The days of struggling providers being saved by a “white knight” are over. Owners can’t just offload their assets and start fresh with a new company, either. This is a pretty big shift from how things used to work.

But there’s something even bigger on the horizon. Medicare and Medicaid have announced they’ll stop buying pumps outright. Instead, all new pump technology will be available only through monthly leases. No more five-year commitments; instead, recipients might have to pay rent on their pump indefinitely, but they’ll be able to switch to a new device whenever they want. It’s a radical change, and no one really knows yet whether it’ll end up costing more or less. What’s certain is that Medicare’s pump policy could be completely different from what other insurers do going forward. This usually creates significant coverage gaps for those entering Medicare and those who may have a spouse on an employer plan.

There’s a lot still to figure out—some changes might be good, some could be great, and some, well… we’ll just have to wait and see.

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This is worrisome for me that this may be the pebble that comes before a rockslide. I currently rely on 3 different DME companies to supply CGM, Pump and urostomy supplies.

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@Rphil2 I appreciate the info, but can’t say I understand all the impact or reasoning sufficiently to comment much. It would be helpful if you and @mohe0001 could cut to the crux or provide practical examples of what you think/know impacts will be ; i.e. long term commitment (likeT:slim) and short term (like Omnipod) and CGM. I get long term pump commitments will change, but not sure I follow the impact…good, bad, just different. Regarding cost: I’ve never known costs to go down; whether covered by insurance or not, costs always seem to rise, whether due to profit for shareholders, cost avoidance to government, complexity of product, or economics of time. I know you and @mohe0001 keep close tabs on this stuff, seem to understand it pretty well; I admit to not grasping a lot of the government, insurance, and medical field language.

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Yes, this is a thing. I think I wrote about it last on Tu because they were asking for public comment.

@jbowler submitted public comment to them.

The new rules don’t go into effect for a while. The concern from our professional lobbyists is that the last time they did something like this, everybody lost access to glucometers. They are concerned the government lacks disease-specific knowledge to administer a program like this without it limiting patient choice or access.

@TomH , I didn’t write to them about this because I’m on a private insurance policy. It’s not really my place to comment. I simply tried to drum up feedback from those who were most impacted.

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I believe Tandem moved to this model last year. It didn’t help their finances - was pretty rocky during the move, but it’s behind them now….

e

I got a new T;Slim pump Dec/Jan no rent.

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I got a new one too. I *think* I’m paying rent but am not 100% sure.

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Here’s the bottom line:

In the immediate future, you probably won’t notice much change—unless you depend on DME (Durable Medical Equipment) companies for things like wheelchairs, toileting devices, CPAP supplies, and more specialized items.

Looking ahead a bit, the landscape could shift. Right now, there are about 77,000 DME providers across the country. Medicare wants to significantly reduce that number. Fewer providers usually means higher prices. It’s worth noting that DME is already a tough business with razor-thin margins, so shrinking the field even more is likely to push some companies out, drive consumer prices up and customer service down (is that even possible for most DME providers).

Over the long term, the least profitable products may vanish from the DME offerings altogether. I can’t say which items will disappear—or whether diabetes-related DME will be affected—but it’s definitely a possibility.

Now, about pump rentals: this change hasn’t started yet. For years, Medicare has required pumps to be rented for a year before purchase, which explains why Medicare pumps get a five-year warranty (compared to the industry standard of four years). Currently we rent a pump for one year and have to keep it for four years there after.

There are still a lot of questions about this proposal. Will pump manufacturers agree to sell pumps to Medicare recipients if the pumps can be returned at any time? When does support begin and end? Will DME companies be willing to rent pumps indefinitely, knowing they could be returned at any moment? I honestly don’t know. Another open question: Will people on Medicare ever get a truly new pump, or will they always get refurbished ones?

Some argue that short-term rentals would give Medicare users quicker access to the latest technology. In theory, that sounds great. But let’s be real—new tech has to be made available to Medicare recipients for that to matter. If it isn’t, all these changes will do is keep Medicare users stuck with old equipment. If I had to guess, that is what a change like this means, unless someone puts a no repair time frame on the rental period.

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I also wrote to them about the DME changes last year. But as far as I can tell, this pump rental proposal is brand new. I also suspect the decision to freeze new DME providers is a direct response to the State of the Union’s push to crack down on fraud and abuse in federal programs—especially after those big fraud allegations in Minnesota. (Full disclosure: I didn’t actually watch the State of the Union address.)

rick

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As for the pump rental plans this would only apply to Medicare. Medicare would be so far out of the normal pattern for insurance as we understand it at least today. I do not know if Tandem went to a new general or Medicare lease arrangement. If so I have not heard details of it.

rick

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Could be. They intend to limit the number of DMEs to around 5 nationally.

Here’s some current into re: intention and request for public input.

Here’s a statement from Diabetes Patient Advocacy Coallition:

“DLC/DPAC continues to strongly oppose the CMS policy that will make CGMs and insulin pumps subject to a competitive bidding program and transition from an ownership model to a rental model. This month, we have been working behind the scenes with other stakeholders to develop our strategy to stop this harmful policy. “

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I think DLC/DPAC having this on their radar is extremely important. Though I have not read DPAC’s reasoning behind the statement regarding harmful policy, I was glad to see I was not overreacting. I think this is off the charts a bad idea.

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I believe it’s currently more like a car loan, “hire purchase” as it’s known in the UK or some US house “options” (though most are just options, as their name suggests). I.e. if you pay the monthly payments for long enough (always much more than the thing is worth) you own it outright; for insulin pumps and cars this happens exactly at the moment when they stop working (cynical comment for effect.)

Assuming people are talking about the proposed changes for DME insulin pumps (I don’t think that this is what @mohe0001 was talking about originally) my understanding is that the proposals will not start to take effect until 2028 and that they will shift insulin pumps from the “car loan” model to a straightforward rental model.

The difference is that with the “rental” model we never end up owning our insulin pump but with the “car loan” model we end up owning the useless piece of outdated junk. [Not so cynical there; this is precisely why Medicare/CMS suggested the change, or at least one stated reason.]

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I worry )a bit) if the rental arrangement will result in more opportunities for insurance to require (and deny) prior authorizations. Some plans even require PA’s for sinsulin refills (I know - that’s not a device, but still…)

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So a question for input from everyone. I have been on an Omnipod for years and only Omnipod. I had never wanted a tubed pump. But I am having more issues with the Omnipod and am thinking to try a Tandem or other tubed pump.

So do people think it’s better to get a tubed pump before the rental of pumps takes place with Medicare, or just go ahead and wait for the rental of pumps to start (if I can wait) ? So I actually own one? I’m thinking back up, although I’ll have a Dash PDM still, but pods in storage might only last so long. My insurance is Medicare with a supplemental so there is no cost to me.

I appreciate any input!

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It’s a good idea to make clear if you are talking about your experience with Part C or with Original [Medicare]; on Original the “plan” (a Medigap plan) is not involved in the decision making, it’s down to the Part B provider. I don’t know, I haven’t heard any statements here, about how that works with regard to insulin (which should be provided by the DME provider, somehow.)

On Part C the provider of the Part C “plan” gets to play with everything; it’s more like private insurance (well, it is private insurance). I’ve no experience of Part C since, when I signed up, I knew I was going to need to claim on the insurance a lot and that typically makes “Original” a better bet; it was breakeven for me if I only needed diabetes treatment but potentially a big win if I needed anything else.

So far as I could make out the change only kicks in in 2028 and it wasn’t clear what would happen to people who were already locked in to a pump. What I’ve learned since is that that is a “free returns” policy on pumps (though check before you buy; some Amazon Prime sales don’t include “free returns” etc…) This seemed to amount to a 90 day or so “trial period” before the lock-in.

I’ve asked about the same change and the options my endo thought were OK (it came down to the Mobi IRC) ended up not an option (I can’t remember why, I’m on “Original” with a Plan G). At least part of my motivation was saving a lot of money per year over a disposable pump; maybe 2K USD.

Pods seem to have a good shelf life. It looks like the battery on switch is physical; the pod switches on when the inserted insulin pushes the plunger back far enough to throw a switch. The cells are manganese alkaline. DuckDuckGo is quoting “5-7 years” for an LR44 which is, IR, what the pods use. That’s almost certainly manufacturer data under ideal conditions but unless your pods were delivered by FedEx in summer (in my experience) they’ve probably been mostly in ideal conditions. It’s still the same ballfield as the “frozen insulin” experiments, well, maybe a little easier to detect the failure case.

Dash PDMs are less reliable because of the lipo battery. The general recommendation for lipos is to keep them charged. IRC charge once every three months but I don’t much care about my PDMs so I don’t bother; not good for the battery life. That doesn’t matter much because there are other, free, programs which will start a Dash pod (AAPS for example) and that’s not likely to change before 2028; it might become illegal but it won’t become impossible.

Bottom line with Medicare though is that it needs a willing endo; trying pumps and then saying, “No deal, you’re fired.” is nice in principle but the endo ends up doing a lot of work and that might interfere with vacation plans, etc.

Honestly, there isn’t a clear-cut answer right now. We’re still very much in the speculation phase. What I do know for sure: in the long run, this rental program just isn’t a good deal for most people on Medicare with type 1 diabetes. That’s why I think we need to push back against it.

Thinking about trying Tandem? Here are a few things to consider. Both Tandem and Beta Bionics have said they plan to release tubeless pumps in 2027. So, if you’re set on going tubeless, it might be worth waiting. Odds are good that at least one of these companies will deliver, and honestly, the whole industry seems to be moving in that direction.

If you prefer a tubed pump, talk it over with your endocrinologist. Medtronic has a 30-day trial program (Medtronic Pump Offer), and if your doctor participates, Beta Bionics has something similar—though it’s not quite as flexible. I believe Tandem offers a trial as well, but I haven’t looked into it as closely since it’s not on my shortlist.

Personally, I’m right where you are. I use Omnipod and I like it, but I’m weighing whether to make a switch now just to sidestep the whole rental mess.

So what’s my plan? For now, I’m waiting. It’s a gamble, and I could end up being wrong—but that’s the nature of it. If we had all the answers, it wouldn’t be a gamble. The one thing I know I can do is continue to speak out against pump rentals in Medicare. That’s the only sure bet I see.

— Rick

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I don’t know anything about Medicare unfortunately…But I recently finished Think Like a Pancreas fourth edition, and it had some really helpful comparisons of pumps and AIDs.

This table sums up a lot of things to think about, if you’re interested in using AID features. I’m sure it skips over a lot too though!

I’m on Tandem t:slim, and I like it. I think they might offer a free trial… The software updates sold me 15 years ago, and I still like that aspect. The latest update included extended boluses up to 8 hours when while using Control-IQ! :raising_hands: A more aggressive target BG option for CIQ is supposed to be in the works (currently locked in at 110, but I usually run about 90 and steady overnight even with that setting – future updates may let it be set to 100 or 90 :crossed_fingers:).

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i do think Tandem has a trial program in conjunction with your Endo, I mean all they can do is say no if you ask. As for AID systems, I love using AID, it rocks.

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