Medicare benefits provide health insurance coverage for most retirees, but the program can sometimes be complicated. In fact, while we are well into 2026 already, you may not have noticed that Medicare has changed in important ways this year if you haven’t started using your benefits heavily yet.
Far too often, seniors don’t find out about the changes in Medicare until they try to get care that is no longer covered, or until they find themselves facing bills that are different from what they expected.
You don’t want to be caught off guard, so be sure you’re aware of these Medicare changes that have happened this year.
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1. New prohibitions on supplemental benefits in Medicare Advantage
One of the first things that you should be aware of is that Medicare Advantage has introduced new coverage limits. Specifically, the Centers for Medicare and Medicaid Services imposed new restrictions on services that the Bipartisan Budget Act of 2018 had authorized for chronic illness sufferers.
Under the Bipartisan Budget Act, Advantage plans were allowed to provide broader coverage for treatments that improved life for people with chronic conditions. However, CMS is now prohibiting coverage for some of these services, including:
- Cannabis
- Certain cosmetic surgeries, including procedures affecting facial lines and atrophied collagen and fat
- Funeral costs
- Hospital indemnity insurance
- Life insurance
- Unhealthy foods
Advantage plan members must be aware of these restrictions on coverage.
2. New preauthorization requirements for certain types of Medicare services
Those with traditional Medicare have been impacted by changes as well.
Specifically, under the WISeR Model, new preauthorization requirements are in place for certain services covered by Medicare. These pre-authorization requirements may apply in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
The new requirements apply to services including:
- Phrenic Nerve Stimulator.
- Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease.
- Epidural Steroid Injections for Pain Management, Excluding Facet Joint Injections.
- Percutaneous Vertebral Augmentation for Vertebral Compression Fracture.
- Cervical Fusion.
- Vagus Nerve Stimulation.
- Induced Lesions of Nerve Tracts.
- Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.
- Electrical Nerve Stimulators.
- Sacral Nerve Stimulation for Urinary Incontinence.
- Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee.
- Incontinence Control Devices.
- Diagnosis and Treatment of Impotence.
- Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis.
- Skin and Tissue Substitutes.
- Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds.
- Wound Application of Cellular and/or Tissue-Based Products, Lower Extremities.
If you need any of these treatments in the affected states, your doctor will likely need to get preapproval from Medicare before your insurance will pay for them.
3. Ten prescription drugs with high costs for Medicare are now available at lower prices
While many of these changes aren’t great news for retirees, there are some positive shifts for seniors.
Specifically, 10 prescription drugs with high costs may now be available at lower prices. That’s because of the Medicare Drug Price Negotiation Program, which allows Medicare to negotiate for the first time to try to lower prices for costly treatments.
The drugs include:
- Eliquis (to prevent blood clots)
- Enbrel (for rheumatoid arthritis and psoriasis)
- Entresto (for heart failure)
- Farxiga (for diabetes, heart failure, or chronic kidney disease)
- Imbruvica (for blood cancers)
- Jardiance (for diabetes or heart failure)
- Januvia (for diabetes)
- NovoLog/Fiasp (insulin for diabetes)
- Stelara (for psoriasis and Crohn’s disease)
- Xarelto (for blood clot prevention)
If you use these drugs, the lower prices could help you keep more money in your retirement plans, like your 401(k) and IRA, instead of having to spend it on medication costs.
These are major changes every senior should be aware of, as shifts in Medicare can impact your retirement planning process in important ways as the cost of healthcare is a leading expense for most seniors.
