New Medicare Advantage Rule Forbids Coverage of Procedures Used by Over 4 Million Seniors

Medicare Advantage plans are an alternative to traditional Medicare that can provide coverage for more services. The Bipartisan Budget Act of 2018 allowed Advantage Plans to cover things that were not directly related to health if they help to maintain or improve functioning for chronic illness sufferers.

In response, Medicare Advantage plans submitted proposals to the Centers for Medicare and Medicaid Services (CMS) to cover different supplementary services, some of which CMS doesn't think should be covered. In fact, the CMS has now codified a non-exhaustive list of services that Advantage plans can't cover and include some common procedures.

Image source: Getty Images.

CMS shoots down Medicare Advantage plans efforts to broaden coverage

According to the new CMS rule taking effect in 2026, Medicare Advantage plans had, in the past, submitted requests to cover certain procedures that CMS says are now off the table. The new rule states:

Some plans have proposed to offer cosmetic services for aesthetic purposes only, such as botulinum toxin injections for lines and wrinkles, in their bids. CMS has previously disapproved these proposals during its bid review because purely cosmetic procedures are not health-related.

CMS has now made clear that this coverage can't be allowed under the expanded 2018 rules, as the requested procedures don't create a "reasonable expectation of improving or maintaining the health or overall function of the enrollee."

Common procedures Medicare no longer covers

Now, CMS has a new blanket rule on this issue. The agency has amended Section § 422.102 to prohibit:

• Cosmetic surgeries, including facelifts
• Cosmetic treatments for facial lines
• Cosmetic treatments for the atrophy of collagen and fat
• Cosmetic procedures to treat bone loss due to aging

The American Society of Plastic Surgeons has indicated that cosmetic surgery has been on the rise, with over 4.1 million people 55 and over undergoing these procedures (28% higher than in 2010). Since Medicare Advantage plans can no longer offer coverage for these treatments as a benefit with this rule change, retirees who want them must ensure they've saved and invested wisely to get the care they need.

The Motley Fool has a disclosure policy.