A Big Change Is Coming To Medicare In 2026

To combat fraud and cut costs, the U.S. Centers for Medicare & Medicaid Services (CMS) will launch a new pilot program In 2026 that will delay some treatments for retirees and other Medicare recipients. Currently, most treatments are performed for patients on Medicare prior to any approvals from CMS. However, starting in 2026, medical providers that choose to participate in CMS' new program, the Wasteful and Inappropriate Service Reduction Model or WISeR, will instead hold off on providing services until after they receive approval from CMS — who has stated the program will consult with AI, medical professionals, and machine learning programs — to see if the treatment in question is deemed necessary.

The purpose of this program, and pre-screening process, is to slash wasteful and fraudulent spending, which represents up to 25% of health care spending in the United States, per CMS, which amounted to up to $5.8 billion in 2022. The WISeR pilot program will be limited to medical providers located in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington, for two different three-year agreement periods, according to CMS' Center for Medicare & Medicaid Innovation.

The Center for Medicare and Medicaid Innovation listed 17 specific treatments that will be targeted under the WISeR program. This includes five stimulator services such as deep brain stimulation for Parkinson's Disease and Urinary Incontinence, two skin and tissue substitutes related to wounds in the lower extremities, as well as lavage (visually guided saline injections) and debridement procedures related to treating osteoarthrosis of the knee. Steroid injections for pain management, cervical fusions, incontinence control devices, and treatment of impotence will also be scrutinized.

These specific treatments were selected since they may have minimal benefit to some patients, and are at a higher risk for fraud and abuse, according to CMS. Typical procedures needed for medical care won't be affected by this program, nor will seasonal vaccinations, cancer and diabetes screenings and any other essential healthcare benefits that are free with Medicare. 

The goal is also to use companies familiar with AI, and other technologies, to speed up and enhance the review process. Companies that participate in the program will be paid a portion of the spending reductions saved through the review process.

Enacted in 1965, Medicare is a health care program that is available to U.S. citizens, and green card holders residing in the United States for more than five years, who are over the age of 65. The program is also available to those under 65 with disabilities, end-stage renal disease, or Lou Gehrig's disease. Although the program is meant to provide affordable healthcare, there was a Medicare price hike for seniors in 2025 thanks to rising drug prices and other health related costs. And while Social Security's COLA estimates have increased for 2026, most of that increase will be used to combat rising Medicare Part B premiums for non-hospital medical care, per USA Today.

While some retirees may be eligible for new senior tax deductions under the One Big Beautiful Bill Act, low-income seniors likely won't receive any tax breaks. Meanwhile, these OBBBA cuts to tax revenue will only speed up the insolvency of Social Security and Medicare's trust funds. This could lead to a 24% cut in benefits for retirees, as well as an 11% cut in Medicare Hospital Insurance payments by 2033, according to the Committee for a Responsible Federal Budget.