September 29

New Diabetes Rule in the Medicare Market


We know everyone's preparing for a busy selling season, but we wanted to talk to you about the new diabetes rule. It has nothing to do with advantage plans or supplements, but it has everything to do with diabetics.

Are you working with someone who has diabetes?

How many of you out there are working with someone who has to deal with diabetes? If you said nobody, then you're probably brand new in this industry. We know that diabetes is everywhere in the Medicare markets and for individuals who are dealing with diabetes. 

diabetes testing

Many times they're testing and pricking their fingers multiple times a day to make sure their blood sugar levels are regulated. Number one, that's painful. Number two, that's an inconvenience. Unfortunately, there are a lot of Medicare recipients that do not test as regularly as they're supposed to. They're not regulating their sugars, which could cause other medical complications, which increases cost.

Medicare Introduced a New Diabetes Rule

Medicare made a change, and this will be the first annual enrollment period that the change has been put in place. It used to be that if someone was on Medicare and they wanted to get one of the continuous glucose meters, something like a freestyle Libre, they would have to have been on multiple insulins and testing about four times a day in order to qualify. This annual enrollment period, you can be the first person to educate your consumer about the new diabetes rule.

The new diabetes rule is: as long as the consumer is taking one insulin, they can qualify for the Dexcom Libre.

The new diabetes rule is that as long as the consumer is taking one insulin, they can qualify for the Dexcom Libre. This is a continuous glucose meter that can be placed on the arm or the stomach, and they last anywhere from 10 to 14 days. The consumer can actually take their smartphone and wave it over the device to get an immediate reading on their blood sugar levels.

Share the good news about the new diabetes rule with your diabetic clients

It makes it much more convenient for the consumer, much less painful. It gives a better and more accurate reading to the doctors because it can be checked anytime throughout the day. They have to change them out every 10 to 14 days, which means a lot less needles and they don't have to worry about being sore. It's important that they understand how to get those supplies because most pharmacies are not able to properly deal with the Dexcoms and the Libres.

We need to educate our consumers that they qualify for these continuous glucose meters if they're taking any insulin. Anytime you bring new pieces of information, such as the new diabetes rule, to the consumer, it gives you the high road. It makes you look like a trusted advisor, and we may not 

new diabetes rule

make a sale based on that. But what it will do is it lets the consumer know that we're engaged in the Medicare market.

Find a Reliable Medical Equipment Provider

We're aware of what's going on in their world. But you need to check if they're getting them at a retail pharmacy, that they're able to file under Medicare Part B. If they are not, it'll be important that you get them through a durable medical equipment provider. Most DME providers are able to file those, and if they are filed properly, they will be covered at 100%. 

new diabetes rule

I personally have run into people over the last year who were getting those Libres at the retail pharmacy. They were paying $100 to $120 for those things for a month supply and come to find out they were paying full cost.

We're able to set people up with a durable medical equipment provider that builds into their Medicare plan. They can be covered at 100% and give out this information to those individuals who didn't qualify in the past.

If you have questions, give us a call at 888-622-9122. We can even give you some recommendations on durable medical equipment providers. We'd love the opportunity to work with you. 

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