17 Medicare Treatments That Could Be Tougher to Access in 2026

Staying healthy and keeping expenses under control are both central to financial well-being, and Medicare plays a major role in helping retirees manage those goals. Still, the federal program can be complicated to navigate, and a pilot known as the Wasteful and Inappropriate Service Reduction, or WISeR, model is expected to make access to some services more difficult for seniors in six states.

People enrolled in Original Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington may have to deal with prior authorization or a post-service, pre-payment review for the 17 services covered here.

Here is a closer look at what each treatment involves and what patients may face if they live in one of the affected states and their doctor recommends one of these procedures.

1. Electrical nerve stimulators

These small electrical devices are commonly used to treat chronic pain. In some cases, they are implanted under the skin as a possible long-term pain relief option.

2. Sacral nerve stimulation

This treatment for urinary incontinence uses a small implanted device that sends a mild electrical current to the sacral nerve.

3. Phrenic nerve stimulator

This implanted device activates the nerve that controls the diaphragm and may help patients who cannot breathe adequately on their own breathe more regularly.

4. Deep brain stimulation

Deep brain stimulation, or DBS, is used for Parkinson's disease and essential tremor. As with other stimulation treatments on this list, it usually involves a minor procedure to place a small nerve-stimulating device.

5. Vagus nerve stimulation

The vagus nerve helps regulate heart rate, digestion, and other functions. Implanting a nerve stimulation device is typically used to treat severe depression, epilepsy, and strokes.

6. Surgically induced nerve tract lesions

This procedure destroys nerve tissue to help control severe, persistent pain from conditions such as lumbar degenerative arthritis and cancer.

7. Hypoglossal nerve stimulation

This treatment for obstructive sleep apnea involves implanting a small device in the chest that stimulates the hypoglossal nerve under the tongue, with the goal of keeping the tongue in place during sleep.

8. Epidural steroid injections

Lumbar epidural steroid injections, or ESIs, are often used to ease lower back pain caused by herniated discs and other spinal conditions. Under WISeR, facet joint injections remain covered without prior authorization.

9. Vertebroplasty

This back-pain treatment involves injecting bone cement into a fractured vertebra damaged by a chronic painful condition such as osteoporosis or cancer.

10. Cervical fusion surgery

During cervical spinal fusion surgery, a surgeon joins at least two vertebrae in the neck to reduce pain.

11. Knee arthroscopy

This common minimally invasive procedure is used to diagnose and treat knee problems, including those linked to knee osteoarthritis.

12. Incontinence control devices

These implanted devices are used to treat urinary incontinence by compressing the urethra, often with collagen injection.

13. Diagnosis and treatment of impotence

Impotence refers to erectile dysfunction, or ED. Treatment can be complex and may include implants, prosthetics, or therapy.

Although ED treatment options were already fairly limited under Medicare, the WISeR guidelines will prevent doctors from collecting the information they need to diagnose ED without prior approval.

14. Percutaneous image-guided lumbar decompression

Spinal stenosis occurs when the spinal canal narrows, leading to pain and limited mobility. This minimally invasive treatment removes portions of ligaments to relieve pressure on the lumbar nerves.

15. Skin-substitute grafts and tissue-based products for diabetic foot ulcers

Skin and tissue substitutes are often used to treat foot and venous leg ulcers that can develop as a result of diabetes.

It is not entirely clear from the WISeR webpage whether all skin-substitute and tissue-based grafts require prior authorization or whether only the two procedures listed next are affected.

16. Application of bioengineered skin substitutes to chronic non-healing wounds on lower limbs

Chronic open wounds that do not heal are common among people with Type II diabetes. They are also very difficult to treat and often do not respond to standard skin grafts.

Bioengineered skin substitutes, including 3D-bioprinted versions, are a relatively new treatment doctors may recommend for diabetic patients with open sores on the lower limbs.

17. Wound application of cellular and/or tissue-based products for lower limbs

Cellular and/or tissue-based products, or CTPs, are skin substitutes made from donated human skin, human tissue, or non-human collagen and tissue.

They do not work as well as standard skin grafts, but depending on the patient, they are sometimes used on open wounds on the lower limbs.

What happens if you need one of these procedures?

Approval could take longer. The Centers for Medicare and Medicaid Services, or CMS, allows providers to choose between prior authorization and a post-service review.

Under WISeR, a generative AI tool will be used to approve or deny claims, but licensed clinicians will make every recommendation for non-payment. If a claim is denied, it can likely be resubmitted.

While waiting for coverage decisions, patients should continue working closely with their doctors to manage symptoms and conditions as well as possible. If a doctor strongly recommends treatment but the claim is denied, patients may need to decide whether paying out of pocket is worth it.

Bottom line

Healthcare costs can put a major strain on retirement finances. Even with Medicare helping reduce some of that burden, households headed by someone age 65 or older spend an average of $7,799 a year on healthcare, according to the Bureau of Labor Statistics.

Even so, it remains important to keep following your doctor's advice and treatment plan closely. Paying for care can be frustrating, but there is no price tag on staying healthy throughout retirement.