Medicare provides essential insurance coverage for millions of seniors 65 and over. However, it is now imposing new restrictions on some services that seniors have come to depend on. In fact, the Kaiser Family Foundation reported that Medicare spent $12.3 billion in 2024 on a group of services that it is now restricting coverage for.
The seniors who received and relied upon this care now face new challenges in trying to get the medical support that they have been using to help treat conditions and improve their health.
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Medicare is severely restricting services for seniors
The services that Medicare is targeting accounted for 5.3% of all Medicare Part B spending in 2024, but lawmakers believe that these services -- relied upon by millions -- are potentially wasteful. In fact, they are being targeted under the Wasteful and Inappropriate Service Reduction (WISeR) Model that Center for Medicare and Medicaid Innovation launched on Jan. 1, 2026.
The WISeR model is a pilot program that will run in six states, which will require pre-authorization before Medicare beneficiaries can get coverage for key services. While pre-authorization is very common in Medicare Advantage plans, it is traditionally very rare for traditional Medicare services. In fact, one reason many retirees opt for traditional Medicare is that they don't want pre-authorization requirements because they won't want an insurer to get between them and their doctor.
Now, however, Medicare will turn to technology, including artificial intelligence (AI), to determine whether to approve treatments that Medicare has been paying billions for.
What services are being restricted?
The services that are included in the WISeR model include:
- Arthroscopic lavage and arthroscopic debridement for osteoarthritis treatment
- Cervical fusion surgery
- Deep brain stimulation for the treatment of Parkinson's and essential tremor
- Electrical nerve stimulators
- Epidural steroid injections (except for facet joint injections) used to manage pain
- Hypoglossal nerve stimulation for the treatment of obstructive sleep apnea
- Impotence treatment
- Incontinence control devices
- Percutaneous image-guided lumbar decompression for the treatment of spinal stenosis
- Percutaneous vertebral augmentation
- Phrenic nerve stimulator
- Sacral nerve stimulation for the treatment of urinary incontinence
- Skin and tissue substitutes
- Surgically induced lesions of nerve tracts
- The application of bioengineered skin substitutes to chronic non-healing wounds affecting the lower limbs
- The application of cellular/tissue-based products for wounds on the lower limbs
- Vagus nerve stimulation
The new restrictions apply to retirees in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
Seniors need to be aware of these new preapproval requirements as they may find themselves being denied services they depend on and having to pay higher out-of-pocket care costs from their retirement plans, like their 401(k).
