Medicare Advantage plans might provide more extensive coverage compared to traditional Medicare.
That said, starting in 2026, some changes will be introduced that will restrict certain services which Advantage plans have been covering up until now.
This change is being implemented for specific reasons, and here’s what will no longer be included in coverage.
What’s driving the changes to Medicare Advantage in 2026?
The modifications to Medicare Advantage will occur in 2026 due to new regulations established by the Centers for Medicare and Medicaid Services (CMS) that adjust rules set in 2018.
- In 2018, the Bipartisan Budget Act allowed Medicare Advantage plans to offer additional benefits for individuals with chronic conditions. This law enabled Advantage plans to provide special supplemental benefits aimed at improving or maintaining the health of chronically ill enrollees, even if those benefits weren’t directly related to medical treatment.
- According to CMS, new restrictions will be imposed in 2026 that limit the types of coverage that can be offered.
In their announcement, CMS stated that they “believe establishing a non-exhaustive list of examples for items and services that fall outside these standards will offer MA organizations and enrollees more transparency and clarity regarding the rules surrounding these benefits.”
Which services are being dropped from Medicare Advantage coverage?
Under the new CMS guidelines, several services that Medicare Advantage plans will no longer cover include:
- alcohol
- cannabis
- cosmetic surgeries like facial treatment, facelifts, collagen procedures, and fat loss treatments
- funeral costs
- hospital compensation insurance
- life insurance
- tobacco products
- unhealthy food
Key takeaways for Medicare Advantage members
Members of Medicare Advantage plans should familiarize themselves with these changes. It’s crucial to understand that neither traditional Medicare nor Advantage plans cover all necessities for retirees, so it’s wise to set aside and invest money specifically for health-related expenses. By planning accordingly for your senior care costs, you can ensure access to the necessary services.
