17 Medicare Treatments That Could Face More Hurdles in 2026

Staying healthy and keeping expenses under control are both important parts of financial well-being, and Medicare plays a major role in helping older adults manage those goals.

Still, working through a federal program as complicated as Medicare is not always easy. A pilot effort called the Wasteful and Inappropriate Service Reduction, or WISeR, model is adding another layer of difficulty for seniors in six states who need certain services.

People with Original Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington may find that doctors must request prior authorization or go through a post-service, pre-payment review for the 17 services covered here.

Here is a closer look at each procedure and what patients may face if they live in a state affected by the pilot program and their doctor recommends one of these treatments.

Electrical nerve stimulators

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

Sacral nerve stimulation

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

Phrenic nerve stimulator

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

Deep brain stimulation

Deep brain stimulation, or DBS, is used to treat Parkinson's disease and essential tremor. Like other stimulation therapies mentioned here, it usually involves a minor procedure to implant a small nerve-stimulating device.

Vagus nerve stimulation

The vagus nerve helps regulate heart rate, digestion and other functions. Implanting a stimulation device is commonly used to treat severe depression, epilepsy and stroke-related conditions.

Surgically induced nerve tract lesions

This approach involves destroying nerve tissue to help relieve severe, ongoing pain caused by conditions such as lumbar degenerative arthritis and cancer.

Hypoglossal nerve stimulation

This treatment for obstructive sleep apnea uses a small device implanted in the chest to stimulate the hypoglossal, or under-the-tongue, nerve and help keep the tongue in place during sleep.

Epidural steroid injections

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

Vertebroplasty

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

Cervical fusion surgery

In a cervical spinal fusion procedure, a surgeon joins at least two vertebrae in the neck to help reduce pain.

Knee arthroscopy

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

Incontinence control devices

These implanted devices treat urinary incontinence by compressing the urethra, often with collagen injections.

Diagnosis and treatment of impotence

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

Although ED treatment options were already limited under Medicare, the WISeR rules could keep doctors from collecting the information they need to diagnose ED without prior approval.

Percutaneous image-guided lumbar decompression

Spinal stenosis is a condition in which the spinal canal narrows, leading to pain and reduced mobility. This minimally invasive procedure removes part of the ligaments to ease pressure on the lumbar nerves.

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 from diabetes.

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

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 difficult to treat and do not respond well to standard skin grafts.

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

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, xenogeneic collagen and tissue.

They do not work as well as standard skin grafts, but in some cases they are used on open wounds on the lower limbs.

What happens if you need one of these procedures?

Getting approval may take longer. The Centers for Medicare and Medicaid Services allows providers to choose either prior authorization or a post-service review.

Under WISeR, generative AI software is used to help approve or deny claims, but every non-payment recommendation is made by licensed clinicians. If a claim is denied, it can likely be resubmitted.

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

Bottom line

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

Beyond the cost, it remains important to keep following a doctor's advice closely. Paying for treatment can be difficult, but good health in retirement is priceless.

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