📋 What Changes Are Coming to Medicare in 2026? (AARP Article)

@SummerOnTheWay1 

The experiment is limited to medical things - procedures, apparatuses, test that have already been determined to be LOW VALUE care.  Processing contractors would find them anyway if they had time to scrutinize the claims better and compare them to the Medicare Coverage Determination database.  Plus, if the doc has adequate records, it will not take but a few minutes to determine if they are prescribing something that is of benefit to the condition of the beneficiary. They do have to have adequate medical records that are accessible for review by the payer of care.

I hope this experiment works BIG TIME so that at least we will have some way to help in holding down Part B premium cost.  I know some beneficiary’s never see their premiums and sometimes their copays/ coinsurance because these are things that their state picks up for them because of their income but it should still matter to them because others do have to pay their Part B premiums and some even have to pay a whole lots more than the standard Part B premium.  Plus they should try to keep down Part B premiums and other cost that are paid by their state, just to keep down the expense to their state’s Medicaid program.  That is who pays these Part B premiums and other cost if a beneficiary does not - We should all try to keep down health care cost for each other especially when undergoing something medical that has been determined by science NOT to be good value care.

People will still get what they medically need - just not stuff that is a low value care.  There is nothing wrong with that and it may even help you avoid some bad outcome.

CMS.gov - WISeR (Wasteful and Inappropriate Service Reduction) Model 

from the source:

The Wasteful and Inappropriate Service Reduction (WISeR) Model will help protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services. The voluntary model will encourage care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare. WISeR will run for six performance years from January 1, 2026 to December 31, 2031 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The application period opened on June 27, 2025. The application period opened on June 27, 2025. 

The WISeR Model tests the use of enhanced technology to decrease certain wasteful (low-value) services shown to have little to no clinical, evidence-based benefit. Technology companies participating in the model will help streamline the review of medical necessity for select items and services earlier in the claims process to: 1) reduce inappropriate utilization, 2) lower spending in Original Medicare, 3) expedite decision making and(4) ease provider administrative burden. 

Background

Original Medicare’s fee-for-service payment structure pays health care providers for the volume of services provided, which may incentivize medically unnecessary treatments, diagnostic tests or other care. The WISeR Model focuses on a specific subset of items and services that may have little to no clinical benefit for certain patients and that historically have had a higher risk of waste, fraud and abuse. This includes skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. Such items and services, when delivered inappropriately, may result in harm to people with Medicare: financial (out-of-pocket costs), physical (i.e., complications like the risk of infection), or psychological (i.e., anxiety over tests and procedures).

[more at the link provided ]