Beginning in 2026, Medicare Advantage plans will no longer be allowed to cover certain cosmetic procedures, following a new rule issued by the Centers for Medicare and Medicaid Services (CMS). The policy outlines a set of aesthetic treatments that are no longer eligible for coverage, regardless of previous plan proposals.
This development follows years of attempts by private Medicare Advantage insurers to expand what they could offer under the 2018 Bipartisan Budget Act, which gave room for broader definitions of “supplemental benefits.” With this updated rule, CMS has drawn a clear boundary around services that do not meet health-related criteria, impacting coverage options for millions of seniors.
CMS Tightens Oversight of Non-Medical Benefits Under Medicare Advantage
Under the Bipartisan Budget Act of 2018, Medicare Advantage plans were granted greater flexibility to offer supplemental benefits not directly tied to medical care, as long as these services were aimed at maintaining or improving function in patients with chronic conditions. Since then, several insurers proposed including cosmetic treatments in their coverage, citing potential improvements to overall well-being.
The CMS has now codified what had previously been discretionary rejections into formal regulation. This includes a non-exhaustive list of prohibited services that cannot be considered medically necessary or functionally beneficial. In particular, the CMS rejected the inclusion of aesthetic treatments such as botulinum toxin injections for facial lines, facelifts, and other purely cosmetic interventions.
The agency clarified that any procedure offered must carry a “reasonable expectation of improving or maintaining the health or overall function of the enrollee.” In their review process, CMS determined that the aesthetic services in question failed to meet this threshold. Consequently, insurers are now explicitly barred from including these offerings in their Medicare Advantage bids.
Over 4 Million Older Adults Impacted by the Rule Change
The rule affects a growing demographic of seniors who have been turning to cosmetic surgery in increasing numbers. The American Society of Plastic Surgeons reports that more than 4.1 million adults aged 55 and older underwent cosmetic procedures in recent years, reflecting a 28 percent rise since 2010. This upward trend suggests that aesthetic care had become a significant consideration for older adults when evaluating healthcare options, especially under Medicare Advantage.
With the new policy, these treatments (such as cosmetic procedures to treat age-related bone loss or facial volume reduction) will have to be paid out-of-pocket. Retirees relying on Medicare Advantage plans for such services will now need to turn to personal savings or private insurance alternatives if they wish to continue receiving them.
While CMS did not list every procedure individually, the language of the rule clearly sets precedent for denying coverage of services aimed purely at altering appearance without demonstrated medical need.
This places a renewed emphasis on the distinction between health-driven care and elective procedures within government-supported insurance programs. As plans prepare for the 2026 implementation, both providers and beneficiaries may need to re-evaluate expectations around supplemental benefits and healthcare planning.
