A new federal pilot program is changing how some seniors access healthcare under traditional Medicare. As of January 1, 2026, approximately 6.4 million beneficiaries in six states must obtain prior authorization for 17 medical services that previously did not require preapproval.
The change marks a notable shift for retirees who rely on traditional Medicare, which has typically allowed patients to receive most covered services without advance approval. The new model introduces additional administrative steps that could result in delayed or denied care for some seniors.
New Prior Authorization Requirements under the Wiser Model
The pilot initiative, known as the Wasteful and Inappropriate Service Reduction (WISeR) model, has been launched in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Under this program, traditional Medicare beneficiaries in those states must now seek preapproval for 17 specified healthcare services.
According to The Motley Fool, traditional Medicare has not generally required prior authorization for most services, in contrast to many Medicare Advantage plans. The WISeR model alters that framework by introducing advance review requirements aimed at limiting what the government defines as “wasteful” care.
The list of affected procedures includes arthroscopic lavage and arthroscopic debridement for osteoarthritis, cervical fusion surgery, deep brain stimulation for Parkinson’s disease and essential tremor, and epidural steroid injections for pain management, excluding facet joint injections. Other services subject to preapproval include hypoglossal nerve stimulation for obstructive sleep apnea, electrical nerve stimulators, vagus nerve stimulation, and surgically induced lesions of nerve tracts.
The program also applies to certain wound treatments and devices. These include bioengineered skin substitutes for chronic non-healing lower limb wounds, wound application of cellular or tissue-based products, skin and tissue substitutes, and incontinence control devices. Percutaneous image-guided lumbar decompression for spinal stenosis, percutaneous vertebral augmentation, sacral nerve stimulation for urinary incontinence, phrenic nerve stimulators, and impotence treatment are also on the list.
According to the report, seniors who fail to obtain preapproval for these services may lose Medicare coverage for them, potentially requiring payment from personal retirement savings.
Impact on Seniors in Participating States
The WISeR model currently applies only to beneficiaries with traditional Medicare in the six participating states. Approximately 6.4 million retirees fall into that category, and the new requirements took effect at the start of the year.
Seniors tend to use more healthcare services than younger populations, which makes Medicare coverage a central component of retirement security. Medicare does not cover every medical expense, but it provides an affordable way for retirees to receive partial payment for most necessary care. The introduction of prior authorization for selected services represents a significant procedural change for affected beneficiaries.
While Medicare Advantage enrollees are accustomed to prior authorization rules, many traditional Medicare recipients are not. The WISeR model therefore introduces a layer of administrative review that may feel unfamiliar to some seniors. The stated goal of the program is to reduce access to services considered wasteful or inappropriate, though retirees who depend on the listed procedures may not share that assessment.
For beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, awareness of the new requirements is likely to be central to navigating care decisions in 2026. As the pilot moves forward, those affected will need to ensure that required approvals are secured before undergoing any of the 17 specified treatments.
