Medicare Advantage 2026: What’s Banned, What’s Cut & What’s Left

If you’re on a Medicare Advantage plan in 2026, you might have recently woken up with a very different policy than the one that you had last year. You might have gone to the pharmacy, or to the dentist, or even to the grocery store and realized the hard way that the perks you were counting on simply aren’t there anymore.

We are seeing a phenomenon this year that I am calling the double squeeze. Usually changes come from one direction, but right now seniors are getting pinched on both sides. On one side, we have the federal government, which has launched a massive crackdown on what they’re calling frivolous spending. On the other side, we have the insurance companies, which are facing massive financial pressure and are quietly tightening the belt on your benefits to save their bottom line.

The result is a landscape where the flashy extras are disappearing and the core benefits are even shrinking. In this video, I’m going to walk you through exactly what has been banned, what has been reduced, and most importantly, how you can navigate these changes so that you don’t get stuck with an unexpected bill.

This is a transcript of our video. You can watch the full video on our YouTube channel: Low Income Relief.

What Is Officially Gone in 2026

First, let’s talk about what is officially gone.

For the last few years, we’ve lived in what a lot of people have called the wild west of Medicare marketing. You probably remember some of those commercials. They seemed to promise everything under the sun to get you to sign up. But the Centers for Medicare and Medicaid Services, or CMS, has officially dropped the hammer and reined some of that in.

So, the new rule for 2026 is pretty simple: if it doesn’t improve your health, the government isn’t going to pay for it. CMS pretty explicitly stated that there must be a reasonable expectation that the item or service will improve or maintain the health or overall function of the patient.

Because of this, a whole category of perks has been wiped off the map. They specifically said that there will not be any more coverage for certain items, including alcohol, tobacco, and cannabis. Believe it or not, some plans were actually trying to include allowances for those. That is strictly prohibited.

Now, cosmetic surgeries are also prohibited. So, no more facelifts, facial line treatments, Botox, or non-medical aesthetic work. There are some exceptions to this. For example, Botox may be prescribed as a treatment for medical conditions like migraines, and reconstructive medical procedures are still allowed. But for the most part, anything that is strictly cosmetic or appearance-based is not going to be allowed anymore.

In addition to that, funeral planning and expense assistance is out. CMS said that funeral services are provided after the death of the beneficiary and therefore cannot be tied to improving that person’s health or function. Life insurance costs and hospital indemnity insurance are also out. They said those are financial products, so those are gone.

They also said that a lot of the broad membership-type programs are not allowed. So no Amazon Prime, no Costco, because in CMS’s view, they can’t make sure that what you’re buying there is helping your health or function. They said it was too broad, so they won’t be doing those either.

One of the biggest shocks for most people is going to happen at the grocery store. Unhealthy food is now officially off the grocery allowance list as well. So if you’ve used your food card for chips, soda, or frozen desserts in the last year, you may find that transaction declined as we go into 2026.

CMS defines non-healthy food as food that does not assist in meeting the nutritional needs of a chronically ill enrollee. However, CMS also says they’re not going to provide a specific list of what that means. So each plan is going to have to figure this out and defend their own choices about what you can and cannot buy with your food card.

And just so you know, Medicare is not being singled out here. This is part of a much larger government trend. We’re seeing similar restrictions roll out in the SNAP program and other programs. States are starting to ban soda and candy purchases in SNAP, sometimes more than that. The government is sending a very unified message across all of these programs: they are done subsidizing unhealthy food and are leaning into this Make America Healthy Again initiative.

One more thing I want you to know here, because I talk about open comment periods a lot and encourage you to leave comments. In the original proposed rule, unhealthy food wasn’t even mentioned. CMS added it in the final rule because they received input from commenters who had questions about food and nutrition. That’s why it’s so important to speak up when those comment periods open on regulations.gov. When you leave comments, they really can influence final decisions.

Insurance Companies Cutting Back

Now, those government changes are public. You can read about them on regulations.gov and hear about them in the news. But the second part of this double squeeze is sneakier. This is coming from the insurance companies themselves.

There are over 20,000 Medicare plans out there, so this part is much harder to track. While the government is cutting the nonsense, your insurance company may be quietly cutting your essentials. This is what some industry experts call the midyear fade.

Insurance companies are businesses. In 2026, their reimbursement rates from the government are being tightened. They can’t just easily raise your premiums, so instead, they trim the edges of benefits.

Industry leader KFF is reporting that fewer plans are offering over-the-counter benefits, meal benefits, remote access technology, and transportation. Even plans that still offer these perks may be tightening them. The brochure might say you have coverage, but the fine print makes it much harder to use.

I want you to watch out for these six specific shrinking benefits.

First is the over-the-counter collapse. Last year, that $50 credit might have bought you any brand of toothpaste or vitamins you wanted. This year, many plans are restricting high-demand items or limiting purchases to a specific online portal instead of your local pharmacy. Even if the dollar amount didn’t change, the value may have.

Second, dental caps. Many Medicare Advantage plans still offer dental, but many are reducing the maximum annual benefit or switching to tighter networks. Your dentist may have been in network last year and out of network this year, and you might not realize it until you’re in the chair. Some people are finding their dental benefits aren’t usable unless they travel very far.

Third is medical-only transportation. If you used your ride benefit for grocery trips or the gym, check for updates. Some plans have reverted to clinical settings only, meaning doctor’s appointments, hospitals, or specialists.

Fourth, meal benefits. Many seniors love the post-discharge meal benefit, often 14 days of meals after a hospital stay. In 2026, the triggers are stricter and may require a specific diagnosis.

Fifth, fitness networks. SilverSneakers is still pretty standard, but boutique yoga studios, Pilates, and specialized local gyms are getting cut. Plans are returning to more basic gym networks.

Finally, the Part B giveback. This is where a plan puts money back into your Social Security check. For many people, this has been slashed. SavingAdvice.com reports that nearly 30% of plans offering this now provide $10 or less, which may be outweighed by higher copays elsewhere.

What You Can Do Right Now

So what can you do about it?

Before you book an appointment, do not assume your dentist, eye doctor, or physical therapist is still in network just because they were last year. Call the office and call your carrier to confirm.

If you use over-the-counter benefits, download the catalog from your plan’s website. Look at what items you actually use and whether the benefit is still valuable to you.

If you were promised something in marketing that isn’t really available or realistic in your area, you can file a formal grievance with your plan.

And if you’re overwhelmed or just have questions about what your plan covers in 2026 or what your options are, you don’t have to figure it out alone. That’s why I recommend our partner, Chapter. They are experts in navigating Medicare and are the only national Medicare adviser that compares and recommends every plan. On average, they help people save over $1,100 on health care costs.

If you have Medicare questions, give Chapter a call. They can help you make sense of the fine print.

Disclaimer: The views and opinions expressed in the content on this website are solely those of the content creators and do not necessarily reflect the views, opinions, or positions of the Social Security Administration, Medicare, Chapter, or its affiliates. Chapter makes no representations or warranties regarding the accuracy, completeness, or reliability of the information provided. All content is intended for informational, educational, or entertainment purposes only and should not be interpreted as official positions of the Social Security Administration, Medicare, Chapter, or its affiliates. Chapter disclaims any liability for actions taken based on this content.

If you need assistance with Medicare, please reach out to Medicare, your local State Health Insurance Program (SHIP), your current Medicare insurance agent/broker/plan, or contact our Medicare partner, Chapter, at 417-319-2139 or visit their website at https://lirlinks.com/chapter. Chapter: Memoir, Inc. d/b/a Chapter is a privately owned, data- and technology-enabled advisory service helping older Americans navigate retirement. Insurance agency services are provided by Chapter Advisory, LLC, a licensed health insurance agency and wholly owned subsidiary of Memoir, Inc. In California, Chapter Advisory, LLC does business as Chapter Insurance Services (Lic. No. 6003691).Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations as well as stand-alone prescription drug plans with Medicare contracts. Enrollment depends on the renewal of those contracts. While Chapter maintains a comprehensive database of Medicare plans nationwide and assists in searching all options, Chapter has contracts with many, but not all, plans. Therefore, Chapter does not offer every plan available in your area. Chapter recommends plans even if they are not directly offered through Chapter. For complete Medicare plan options, please visit Medicare.gov, call 1-800-Medicare, or contact your local SHIP office.