Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
Big changes are coming to Medicare in 2026, and many people don’t fully understand their impact. Doctors warn that payment rates are squeezing their practices. Telehealth flexibilities from the pandemic may be expiring. Additionally, benefits may be cut in ways that don’t appear on your Medicare card but could affect how quickly you access care, what kind of care is available, and how many providers accept Medicare.
Medicare Physician Payment Rates
Financial Strain
Hard as it may be to believe, physicians and medical groups say they’re in a precarious financial position. In 2026, CMS has proposed a 3.62% payment increase under the Physician Fee Schedule. This includes a 2.5% payment adjustment under the One Big Beautiful Bill Act. However, this follows a 2.83% payment cut for 2025 that has already impacted practices. So, in essence, providers will be paid less when accounting for inflation and rising costs.
Rising Costs
Rising practice costs (staff, insurance, regulatory burdens, etc.) have increased at a staggering rate. Payment rates have not kept pace with inflation or costs, leaving margins thin or even negative! The 2026 “increase” may actually only allow practices to break even.
Impact on Patients
As a result of this, there may be reduced provider participation. Doctors may be less willing to accept Medicare patients. This means fewer available visits and services and longer wait times. We will likely see more severe effects in rural and underserved areas.
Additionally, smaller practices may lack the capacity to take new Medicare patients or may cut certain services. And for those with complex cases, services could be reduced or eliminated due to higher costs.
So, while official benefits remain unchanged, access to care could worsen (delays, travel distance, fewer service options).
Telehealth Flexibilities
Telehealth was massively expanded during the COVID-19 public health emergency. It allowed patients to receive care remotely from home, without location restrictions or in-person requirements.
Unfortunately, these provisions are set to expire soon! Non-behavioral telehealth services are set to expire September 30, 2025. And a previously eliminated rule requiring an in-person visit within 6 months prior for mental health and behavioral telehealth is set to expire October 1, 2025 (except in some rural areas where they may extend until January 1, 2026).
Rural residents, mental and behavioral health patients, and patients who are homebound or with limited mobility will be the most severely affected.
Congress
There may be some hope on the horizon. The Connect for Health Act of 2025 would permanently lift older restrictions, and the Telehealth Modernization Act aims to extend or make telehealth access permanent. If these pieces of legislation are passed, it would drastically change the face of telehealth in Medicare.
Provider Participation
Currently, nearly all hospitals and doctors accept Original Medicare, but with stagnant reimbursement and rising operational costs, more doctors may reconsider participation.
They could potentially limit new Medicare patients, reduce their hours or available services, or drop Medicare entirely to focus on private insurance or self-pay patients!
So make sure to monitor announcements and updates from CMS (Centers for Medicare & Medicaid Services) and confirm that your doctor will continue accepting Original Medicare or your Medicare Advantage plan.
