Medicare Advantage Coverage Changes: Items Excluded Starting 2026
Medicare Advantage Plans are set to undergo significant changes starting in 2026. These adjustments primarily relate to the coverage of certain services. The new regulations will restrict some benefits that Advantage Plans have previously offered.
Reasons Behind Medicare Advantage Coverage Changes in 2026
The Centers for Medicare and Medicaid Services (CMS) has initiated these changes. A rule established in 2018 allowed Medicare Advantage Plans to provide additional supplemental benefits for individuals with chronic illnesses. This included the provision of Special Supplemental Benefits for the Chronically Ill, aimed at enhancing the health and function of these patients.
With the upcoming changes, CMS is now tightening the limits on some covered services. The intention is to provide clarity and strict guidelines around what services Medicare Advantage Plans can support. According to CMS, “codifying a nonexhaustive list of examples of items or services that do not meet these standards will provide transparency and greater certainty for MA organizations and enrollees about the rules that govern these benefits.”
Services Excluded from Medicare Advantage Coverage Starting 2026
As per the new CMS regulations, the following services will no longer be covered by Medicare Advantage Plans:
- Alcohol
- Cannabis
- Cosmetic surgeries, including facelifts and treatments for facial lines
- Funeral costs
- Hospital indemnity insurance
- Life insurance
- Tobacco products
- Unhealthy foods
Importance of Understanding Coverage Changes
Members of Medicare Advantage Plans must be aware of these coverage adjustments. These changes indicate that neither traditional Medicare nor Advantage Plans cover all necessary healthcare services for retirees. Therefore, it is vital for seniors to save and invest adequately for future healthcare needs. Planning financially for healthcare ensures retirees can afford essential services as their needs change over time.
