Medicare Advantage Will Officially Exclude These Items in 2026
- - Medicare Advantage Will Officially Exclude These Items in 2026
Katie Brockman, The Motley FoolJanuary 15, 2026 at 12:50 AM
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Key Points -
Special Supplemental Benefits for the Chronically Ill (SSBCI) affects Medicare enrollees with chronic medical conditions.
Services under this expansion should improve or maintain enrollees' health.
In 2026, the Centers for Medicare and Medicaid Services (CMS) is imposing new restrictions on what's covered.
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The Medicare Advantage plan is a popular alternative to original Medicare, as it often includes more services bundled together into a single plan.
They can be subject to more changes, however, and retirees can expect new rules to take effect in 2026. If you're currently enrolled in an Advantage plan, here's what will no longer be covered this year.
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Medicare changes coming in 2026
Special Supplemental Benefits for the Chronically Ill (SSBCI) was introduced as part of the Bipartisan Budget Act of 2018, expanding supplemental benefits for enrollees with chronic medical conditions.
SSBCI services don't have to directly relate to a person's health, but they should have a reasonable expectation of improving or maintaining the overall health or function of those with chronic illness.
In 2026, the Centers for Medicare and Medicaid Services (CMS) is placing new restrictions on what will and will not be covered under SSBCI. Goods and services that will not be covered include:
Alcohol, tobacco, and cannabis products
Life insurance and hospital indemnity insurance
Funeral planning and expenses
Procedures that are strictly cosmetic, such as facelifts
Broad membership programs that offer products or services unrelated to health
Non-healthy foods
While many of these restrictions are clear-cut, some are more vague. For example, in its rule, CMS explained that it will not provide specific examples of "non-healthy" foods that are no longer covered by the grocery allowance.
Instead, it will be up to each plan to "determine what is allowable and design their food benefits to ensure that those benefits assist in meeting the nutritional needs of a chronically ill enrollee."
This list is also subject to change, according to CMS. "[T]his is a non-exhaustive list of benefits and services that may not be offered as an SSBCI," the agency noted in its rule. "All benefits must be proposed in a plan's annual bid and are subject to review by CMS."
What does this mean for you?
Because some of these changes are plan-specific, the exact coverage you'll receive will depend on which Medicare Advantage plan you're enrolled in. But generally speaking, any product or service must improve your health or function in some way to be covered under SSBCI in 2026.
Some services, such as cosmetic surgery and life insurance, aren't covered by most Medicare plans anyway, so that's not necessarily a new change for most enrollees.
However, with some retirees facing more out-of-pocket costs in 2026, it's wise to ensure you have at least some funds set aside for healthcare services to help protect your financial future.
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