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

Good health and a balanced budget are two key elements of financial fitness, and Medicare is essential to helping you achieve both goals.

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

Original Medicare patients in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington have doctors who must either seek prior authorization or undergo a post-service, pre-payment medical review for the 17 services covered in this article.

Below, we detail what each of these procedures entails and explain what is likely to happen to you if you live in a state affected by the pilot program and your doctor recommends one of these common treatments.

Electrical nerve stimulators

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.

Sacral nerve stimulation

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

Phrenic nerve stimulator

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

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.

Vagus nerve stimulation

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.

Surgically induced nerve tract lesions

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

Hypoglossal nerve stimulation

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.

Epidural steroid injections

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.

Vertebroplasty

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

Cervical fusion surgery

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

Knee arthroscopy

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

Incontinence control devices

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

Diagnosis and treatment of impotence

"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.

Percutaneous image-guided lumbar decompression

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-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 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.

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

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.

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

Cellular and/or tissue-based products (CTPs) are skin substitutes that can be made from donated human skin, human tissue, or non-human (xenogeneic) 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.

What happens if you need one of these procedures?

It can take longer for you to get approval. The Centers for  Medicare and Medicaid Services (CMS) lets providers choose prior authorization or a post-service review.

According to WISeR, while a generative AI software program will be used to approve or deny claims, licensed clinicians make every non-payment recommendation. 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 claim gets denied, you may need to consider whether it's worth paying for the treatment yourself out of pocket.

Bottom line

Healthcare costs can take a major toll on your retirement plan. After all, even with Medicare to help eliminate some money stress, households headed by someone age 65+ spend an average of $7,799 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.

You May Also Like

23 Ways To Get Money Without Getting A Second Job

By FinanceBuzz Editors

How To Save Money on Car Insurance: 12 Ways to Lower Rates

By Elyssa Kirkham

10 Things Seniors Born Between 1941-1969 Could Take Advantage Of

By FinanceBuzz Editors

19 Dumbest Things Smart People Waste Money On

By Team FBZ

7 Moves If You Want to Stop Living Paycheck to Paycheck

By FinanceBuzz Editors

7 Clever Ways to Crush Your Debt

By FinanceBuzz Editors

Save Money and Get Huge Discounts on Everyday Purchases

AARP Benefits

• Huge discounts on travel, groceries, prescriptions and more
• Access to financial planning resources and health tools
• Join AARP and get 25% off with automatic renewal

Become a member now!

---

Subscribe Today

Learn how to make an extra $200

Get vetted side hustles and proven ways to earn extra cash sent to your inbox.

or

Subscribe Now →

By submitting this form you agree to receive emails from FinanceBuzz and to the privacy policy and terms