Americans Concerned New Medicare Advantage Coverage Limitation Is Too Vague

Starting in 2026, Medicare Advantage began imposing new limits on coverage. Unfortunately, many people choose Medicare Advantage precisely because it tends to provide broader benefits than traditional Medicare offers. These new limits are a disappointment to many, and some have expressed concern about some of them being too vague.

Here's what you need to know about the limits, as well as the source of concern about the lack of clarity.

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New Medicare Advantage limits

The new limits on Medicare Advantage are related to a program put in place by the Bipartisan Budget Act of 2018. The Act expanded supplemental benefits available to Medicare Advantage plan enrollees with chronic illnesses. The assistance was called Special Supplemental Benefits for the Chronically Ill, and it enabled coverage of non-medical services that were reasonably expected to improve or maintain the health or function of someone with a persistent medical condition.

However, the Centers for Medicare and Medicaid Services severely curtailed the list of things that could be covered under this program with a new rule taking effect in 2026. Specifically, coverage is prohibited under the new rule for:

• Alcohol
• Cannabis and tobacco products
• Specific cosmetic surgeries and procedures
• Funeral costs, planning, and expenses
• Life insurance
• Hospital indemnity insurance
• Unhealthy foods

Americans expressed concern that the rule was too vague

While CMS stated in the rule that "We believe that codifying a non-exhaustive list of examples of items or services that do not meet these standards will provide transparency and greater certainty for MA organizations and enrollees about the rules that govern these benefits," not everyone agreed.

In fact, in the published rule, CMS stated that "several commenters requested more clarity on food and nutrition specifically." There were also specific requests for CMS to clarify how plans are allowed to provide food for disease prevention and diet management, while others asked for more insight into how the premise of "food is medicine" could be applied.

Unfortunately, while CMS did provide an answer to these concerns, the details still may not be clear enough. CMS said it would not provide any type of list of foods that would or wouldn't be considered unhealthy, but just reiterated that plans could provide food and produce to help chronically ill enrollees meet their nutritional needs. Without more guidance, it's possible that many Advantage plans won't know how to create a program that does offer the necessary food assistance. As a result, enrollees with chronic illnesses will lose the opportunity to get this kind of assistance entirely.

Retirees who are on Medicare Advantage, and particularly those using these supplemental benefits, should be aware of this concern and its potential effect on the services and products their plan will pay for as they do their retirement planning. If Advantage plans are deterred from either introducing new benefits or from maintaining existing benefits because of the rule changes, some of the sickest enrollees may end up facing more costs that must come out of their Social Security or other retirement plans.

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