What's New

Medicare continues to fully cover updated COVID-19 vaccines at no cost to beneficiaries, provided they’re administered by Medicare-approved providers. This includes the latest 2024–2025 vaccines targeting Omicron variants like KP.2 and JN.1 from Pfizer-BioNTech, Moderna, and Novavax. In-home vaccination support also remains in place, offering additional payments to providers to reach homebound individuals—a key benefit for seniors with limited mobility or in long-term care.

Although CMS ended its vaccine mandate for healthcare staff in Medicare- and Medicaid-certified facilities in mid-2023, facilities are still required to educate and offer COVID-19 vaccines. A new reporting requirement, item O0350 in the Minimum Data Set (MDS), helps track whether long-term care residents are “up-to-date” on COVID-19 vaccines as per CDC guidelines, reinforcing ongoing efforts to monitor vaccine uptake.

However, the broader policy landscape has shifted under Health Secretary Robert F. Kennedy Jr., who has replaced the CDC’s vaccine advisory panel with members skeptical of vaccine safety. This has led to the withdrawal of CDC booster recommendations for certain groups, raising concerns among health professionals. While Medicare coverage remains unchanged for now, beneficiaries should stay alert to future policy changes and consult healthcare providers for the most current guidance.

Many people are well aware of the benefits of telehealth, including convenience and flexibility, as well as access to a broader range of specialists. Under Medicare’s original rules, telehealth services were intended mainly for rural residents , with the aim of connecting patients with remote specialists from an approved medical facility, like a local clinic. During the COVID-19 pandemic, Medicare temporarily made it easier for people to get care from home through telehealth, no matter where they lived. This change allowed beneficiaries to have video or phone visits with their doctors right from their living rooms — a huge help for people with mobility challenges or those living in urban or suburban areas.

Starting October 1, 2025, unless new laws are passed, this pandemic-era home access will end for many services under Original Medicare. The guidelines will revert back to the original rule, meaning in most cases, you will need to be at an approved medical site in a rural area to use telehealth. There are a few notable exceptions, including mental health counseling, substance use disorder treatments, dialysis visits, and a few other services, which will still be covered from your home, wherever you live. If you rely on telehealth, it’s smart to ask your provider now what services you can still get from home, and whether they offer extra telehealth benefits beyond basic Medicare. Some Medicare Advantage Plans may offer more telehealth benefits than the basic coverage in Original Medicare. Stay informed and consult with your licensed insurance agent to help you plan ahead for any changes to your care routine in the coming months.

Centers for Medicare & Medicaid Services (CMS) is launching a new pilot program called the Working to Integrate Safe and Effective Review (WISeR) Model. This model will test whether a more streamlined prior authorization process can help reduce unnecessary and often costly services in Original Medicare, while protecting beneficiaries from care that may not improve their health. The WISER Model will focus on certain services that data shows may sometimes be overused or provide a lower clinical value, including skin and tissue substitutes, electrical nerve stimulators, and knee arthroscopy.

The program will begin in selected geographic areas and is expected to run for up to five years, starting in 2026. If your provider participates, they may work with Medicare contractors to review medical claims and documentation for these services to ensure they meet updated clinical guidelines. There will be no change to what Medicare covers, and beneficiaries should not experience any reduction in medically necessary care. According to CMS , this effort is part of a broader strategy to curb wasteful spending, promote safe and effective treatment, and maintain the integrity of the Medicare program.