17 Medical Treatments That May Be Harder To Get On Medicare in 2026

Good health and a balanced budget are two key elements of a stress-free retirement, and Medicare is essential to helping you achieve both goals.

However, navigating a federal program as complex as Medicare can be tricky, and a new pilot program — known as the Wasteful and Inappropriate Service Reduction (WISeR) model — is about to make it even more difficult for seniors in six states to access a few services.

Starting January 1, 2026, Original Medicare patients in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington will need their doctors to seek prior authorization for the 17 services covered in this article before they can receive the recommended treatment.

Below, we detail what each of these procedures entails and explain what is likely to happen to you in the future if your doctor recommends one of these common treatments.

These small electric devices are frequently used to treat chronic pain. In some cases, they may be implanted beneath the skin as a potential option for long-term relief.

This treatment for urinary incontinence involves implanting a small device that delivers a small electric current to the sacral nerve.

This implanted device stimulates the nerve that controls your diaphragm, a treatment that may help patients who can't breathe enough on their own breathe more regularly.

Deep brain stimulation (DBS) is a treatment for patients with Parkinson's disease and essential tremor. Like other stimulation treatments listed in this article, it usually involves a minor surgery that places a small nerve-stimulating device.

The vagus nerve is responsible for controlling your heart rate and digestion, among other things. Typically, implanting a nerve stimulation device is a treatment for severe depression, epilepsy, and strokes.

This treatment involves destroying nerve tissue to help manage intense, ongoing pain from conditions like lumbar degenerative arthritis and cancer.

This treatment for obstructive sleep apnea involves implanting a small device in your chest that stimulates your hypoglossal (under-the-tongue) nerve, ideally keeping your tongue in place while you sleep.

Lumbar epidural steroid injections (ESIs) are usually prescribed to help alleviate pain in your lower back resulting from herniated discs and other spinal conditions. Note that under WISeR, facet joint injections are still covered without requiring pre-authorization.

This treatment for back pain involves injecting concrete into a fractured vertebra damaged by a chronic, painful condition like osteoporosis or cancer.

During a cervical spinal fusion surgery, a surgeon fuses at least two of the vertebrae in your neck together to alleviate pain.

This common, minimally invasive procedure is used by surgeons to diagnose and treat knee problems, including those related to osteoporosis.

These implanted devices are used to treat urinary incontinence by compressing your urethra, often by injecting collagen.

"Impotence" refers to erectile dysfunction (ED). Treatment is varied and complex and could include implants, prosthetics, or therapy.

While ED treatment options were already fairly limited in terms of Medicare coverage, the WISeR guidelines will prevent your doctor from gathering the data they need to make an ED diagnosis without prior approval.

Spinal stenosis is a condition where your spinal canal narrows, causing pain and immobility. This minimally invasive treatment involves removing portions of your ligaments to reduce pressure on your lumbar nerves.

Skin and tissue substitutes are often used to treat foot and venous leg ulcers that can result from conditions such as diabetes.

It's not immediately clear from the WISeR webpage whether all skin-substitute and tissue-based grafts require prior authorization or if the only affected procedures are the two we list next.

Chronic open, non-healing wounds are common for people suffering from Type II Diabetes. They're also extremely hard to treat and don't respond to typical skin grafts.

Bioengineered skin substitutes, including 3D-bioprinted skin substitutes, are a relatively new therapeutic treatment that doctors may recommend for diabetic patients with open lower-limb sores.

Cellular and/or tissue-based products (CTPs) are a skin substitute that can be made from donated human skin, human tissue, or non-human (xenogenetic) collagen and tissue.

They don't work as well as ordinary skin grafts, but depending on the patient, they're sometimes used on open wounds on the lower limbs.

It could take longer for you to get approval. Although there isn't much information available about this program's rollout in the six states we listed, we know these procedures won't be covered by Medicare unless your doctor submits a statement to Medicare outlining why they recommend this treatment in your particular case.

According to WISeR, while a generative AI software program will be used to approve or deny claims, there will still be some human oversight in determining whether Medicare will pay for your treatment. If your claim is denied, you can likely resubmit.

In the meantime, while you wait for coverage, you should continue to work closely with your doctor to manage your conditions and symptoms as best you can. If your doctor strongly recommends the treatment but your somehow claim gets denied, you may need to consider whether it's worth paying for the treatment yourself out of pocket.

Healthcare costs can take a major toll on your retirement plan. After all, even with Medicare to help alleviate the strain, households headed by someone age 65+ spend an average of $57,818 per year on healthcare alone, according to the Bureau of Labor Statistics.

Cost aside, it's important that you continue to consult with your doctor and follow their care recommendations closely. It's a pain to pay for treatments, but you can't put a price tag on enjoying good health throughout your retirement.