Medicare 2026: What Healthcare Revenue Leaders, RCM Teams & Billers Need to Know
Editor's Note:
The Medicare 2026 rules were updated on November 14, 2025. This guide reflects Arrow’s current understanding of the rule and will be updated as new guidance becomes available.
Introduction
Medicare’s 2026 changes are more than policy updates — they will reshape how care gets reimbursed, what patients owe, and how revenue cycle teams operate day to day.
For leaders already managing rising denials, payer variability, and staffing pressure, these changes introduce new complexity at a time when teams can least afford it.
This guide breaks down what’s changing, why it matters, and how revenue teams can stay ahead — not just compliant.
Table of Contents
What is changing in Medicare for 2026?
Medicare’s 2026 updates affect every major part of the revenue cycle:
Reimbursement.
New PFS rates, new mandatory payment models, CCM/APCM/RPM adjustments
Operational workflows.
More eligibility work, more coding nuance, more documentation clarity required.
Patient financial responsibility.
Higher premiums and deductibles
Medicare Advantage.
Major insurer exits and reduced plan availability
Telehealth.
Expanded permanent allowances and reduced frequency limits
These changes create a more volatile reimbursement environment — one where manual processes will struggle to keep up.
Medicare is changing fast. Your workflow shouldn’t.
See how Arrow keeps revenue teams compliant and ahead of policy shifts.
Key reimbursement updates
Part B premium & deductible increases
Standard monthly premium
$202.90
Annual deductible
$283
Why this matters: Higher patient responsibility means more conversations up front, more payment plans, and more patient A/R — all areas already under pressure.
Physician Fee Schedule (PFS) updates
Most Medicare E&M encounters will see reimbursement increases, with larger gains for APM participants.
Additional updates include:
New mandatory reimbursement models for back pain and heart failure
Updated rules for CCM, APCM, and RPM reimbursement
Telehealth expansions:
New codes
Fewer frequency limits
More permanent hybrid workflows
Why this matters: Higher reimbursement doesn’t help if claims get denied. Teams must adjust coding, documentation, and workflow rules to avoid underpayment and preventable rework.
Medicare Advantage (MA) market shifts
In 2026, many major insurers are reducing or exiting MA plans in multiple counties.
This will create:
Fewer plan options for patients
More eligibility confusion
Shifting networks
New payer rules to monitor
A surge in eligibility-related denials
Why this matters: Teams relying on manual eligibility checks will feel this shift immediately — especially during Q1 churn.
Operational impacts for revenue cycle teams
2026 introduces meaningful workflow challenges:
More patient responsibility to collect
More payer churn and MA variability
More coding/documentation changes
Increased eligibility checks
More operational burden on short-staffed teams
Higher denial risk
Teams relying on manual processes will feel this shift most.
What this means in the simplest terms
Revenue cycle teams must prepare for:
More up-front verification
More unpredictable payer behavior
More complex coding rules
More potential for rework and denials
More pressure on lean billing teams
Medicare rules will continue to change — but your workflows don’t have to break every time they do.
Compliance deadlines & timing
Most changes take effect January 1, 2026, with MA adjustments and reimbursement updates rolling out throughout the year.
Teams must update:
Eligibility processes
Payer configuration
Fee schedule tables
Coding systems
Denial prevention rules
Patient financial workflows
Internal training & documentation
The cost of not updating these systems will show up quickly, in denials, days in A/R, and missed reimbursement.
How Arrow Can Help
Arrow keeps your revenue cycle resilient and adaptive — even as Medicare rules shift.
Arrow gives revenue cycle teams the intelligence and automation they need to stay ahead of policy changes — not react to them.
Real-time reimbursement modeling: Model how PFS changes and new payment models impact your bottom line.
Automated payer + CMS rule updates. Arrow updates your system behind the scenes meaning your workflows stay compliant automatically.
AI-powered eligibility verification. Surface coverage changes, MA exits, and benefit shifts instantly.
Medicare-focused denial prevention. Flag coding errors, documentation gaps, and policy misalignment before claims go out the door.
Adaptive workflows.
When rules change, Arrow adjusts tasking, routing, and next steps in real time — so your team always stays ahead.