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What Is the WISeR Model — and How Could It Affect Your Medicare Coverage?

Wed, 25 Mar 2026 06:00:05 GMT

Understanding Medicare’s New Pilot Program Focused on Prior Authorization and Medical Necessity

If you’ve heard about WISeR recently and aren’t sure what it means or how it might impact your Medicare care, you’re not alone.

The Wasteful and Inappropriate Service Reduction (WISeR) Model is a new Medicare pilot program designed to curb unnecessary or low-value medical services and improve the efficiency of Medicare spending. It represents a significant change to how some services are reviewed and approved in Original Medicare (Part A and Part B).

What Is the WISeR Model?

WISeR stands for Wasteful and Inappropriate Service Reduction. It is a pilot initiative from the Centers for Medicare & Medicaid Services (CMS), the agency that runs the Medicare Program, that uses advanced technology, along with clinical review, to determine whether certain services are medically necessary before Medicare pays for them.

In simple terms:

Medicare has identified services that are considered high-risk for waste, overuse, or low clinical value.
For those services, prior authorization (approval before treatment) may now be required.
Requests are reviewed using enhanced data tools (such as artificial intelligence and machine learning) alongside established clinical guidelines. It is important to note that coverage decisions under the WISeR model are not based solely on these data tools. A human clinical reviewer is involved in all final coverage decisions when a service is recommended for denial.

The goal is to ensure Medicare pays for care that is medically appropriate and supported by evidence-based standards.

Where Is WISeR Being Piloted?

The WISeR Model is currently being tested in the following six states:

Arizona
New Jersey
Ohio
Oklahoma
Texas
Washington

If you live in one of these states and have Original Medicare, you may be affected — especially if your doctor recommends one of the services included in the program.

Medicare Advantage plans are not part of the WISeR Model, as they already use their own prior authorization and utilization review processes.

Which Services Are Included?

CMS has identified specific services that will require additional review in the pilot states. These include:

Musculoskeletal and Pain-Related Services

Skin and tissue substitutes
Epidural steroid injections for pain management
Facet joint injections
Sacroiliac joint injections
Knee arthroscopy for osteoarthritis
Cervical spinal fusion
Lumbar spinal fusion
Vertebroplasty and kyphoplasty
Arthroscopic shoulder procedures

Neuromodulation and Implantable Devices

Electrical nerve stimulator implants
Peripheral nerve stimulation
Spinal cord stimulation procedures
Implantable pain pumps
Neurostimulator trial procedures
Replacement or revision of implanted nerve stimulators

Other Services

Certain urological procedures for erectile dysfunction
Select wound care services

If one of these services is recommended, your provider may need to obtain prior authorization before Medicare will pay for it.

How Could This Affect Your Care?

If you are enrolled in Original Medicare in one of the pilot states, you may notice:

Prior Authorization Requirements
Your provider may need to submit medical records or documentation before treatment can be approved.

Possible Delays
Reviews may take additional time, which could delay scheduling of a procedure.

Coverage Decisions Based on Medical Necessity
If Medicare determines a service does not meet established clinical guidelines, it may deny payment.

It is important to understand that the purpose of the program is to reduce inappropriate or unnecessary services — not to deny medically necessary care. However, additional review steps may require more coordination between patients and providers.

What Should Medicare Beneficiaries Do?

If you live in one of the affected states, consider the following steps:

Ask your provider whether a recommended procedure requires prior authorization.
Confirm that your medical records clearly document the need for the service.
Carefully review any Medicare notices you receive.
Understand your right to appeal if a service is denied.

Working with a knowledgeable insurance professional can also help you better understand how these changes may impact your coverage.

Where to Learn More

For official information directly from CMS, visit:

https://www.cms.gov/priorities/innovation/innovation-models/wiser

Conclusion

The WISeR Model is a Medicare pilot program designed to reduce waste and ensure certain services meet clinical guidelines before Medicare pays for them. If you are enrolled in Original Medicare and live in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, this program could affect how certain procedures are approved.

Staying informed, asking questions, and maintaining open communication with your provider are the best ways to navigate these changes confidently.

Glaucoma and Medicare

Wed, 18 Mar 2026 06:00:04 GMT

What You Need to Know About Protecting Your Vision

Did you know that about half of people with glaucoma don’t even know they have it?

Glaucoma is often called the “silent thief of sight” because it develops slowly and often with no noticeable symptoms in the early stages. By the time vision changes become obvious, it usually means permanent damage has already occurred.

What is glaucoma? It’s actually a group of eye diseases, not just one single disease. What they all have in common is that they damage the optic nerve, which is the vital connection between your eye and your brain. It’s often associated with increased pressure inside the eye, but it can occur even when eye pressure is normal. Left untreated, glaucoma can lead to permanent vision loss and even blindness.

Early detection and treatment are crucial to slow or prevent further vision damage. That’s why regular screenings are essential if you are at a higher risk for glaucoma based on your genetics or family history.

Why Early Detection Matters

In its early stages, glaucoma typically has no warning signs. There’s no pain or sudden changes in vision. The most common form, called open-angle glaucoma, gradually reduces peripheral (side) vision first. Because central vision remains clear for a long time, it can take quite a while to realize anything is wrong.

Other, less common types, such as angle-closure glaucoma, can develop more suddenly and may cause more obvious and acute symptoms like severe eye pain, headache, nausea, blurred vision, or seeing halos around lights. These symptoms require immediate medical attention.

The only way to know if you have glaucoma is through a comprehensive, painless eye exam that includes specific tests to check:

Eye pressure
Optic nerve health
Peripheral vision
Drainage angle of the eye

According to the National Eye Institute , regular eye exams are critical, especially as we age, because early treatment with prescription eye drops, laser therapy, or surgery can help prevent further vision loss.

Vision lost from glaucoma cannot be restored, which makes early detection essential.

Medicare Coverage for Glaucoma Screenings

Medicare Part B covers glaucoma screenings once every 12 months for people who are considered high risk (see the list below).

The screening must be performed (or supervised) by an eye doctor who is legally allowed to provide the service in your state, such as an ophthalmologist or optometrist.

If you qualify as high risk and receive your screening from a provider who accepts Medicare assignment, Medicare Part B will cover 80% of the approved amount (once your Part B deductible has been met). You would be responsible for the remaining 20% as coinsurance.

It’s important to confirm that your provider accepts Medicare assignment to help minimize out-of-pocket costs. If you have a Medicare Advantage plan, coverage rules may vary slightly, so review your plan details, or ask us to help determine what your coverage is.

Who Is at Higher Risk for Glaucoma?

While anyone can develop glaucoma, certain groups have a higher risk. Medicare considers you at high risk if at least one of the following applies:

You have diabetes
You have a family history of glaucoma
You are African American and age 50 or older
You are Hispanic and age 65 or older

Because risk increases with age, glaucoma screening becomes even more important for Medicare beneficiaries.

Protecting Your Vision Starts with a Conversation

If you fall into a high-risk category, talk with your primary care provider or eye doctor about scheduling a glaucoma screening. Your vision plays a major role in your independence, safety, and overall quality of life. When it comes to your eyesight, waiting for symptoms isn’t a safe strategy. A simple, painless screening once a year could help preserve it for years to come.

If you have questions about how your Medicare coverage works, including preventive screenings like glaucoma testing, reach out to review your benefits and make sure you’re taking full advantage of what’s available to you.

Delicious Foods That Fight Diseases

Wed, 11 Mar 2026 06:00:02 GMT

Eat for your health

Eating well is one of the simplest ways to support long-term health. While no food can cure or prevent disease on its own, many everyday foods contain nutrients that help strengthen the immune system, reduce inflammation, and support overall wellness. The good news? Many of these foods are both familiar and delicious.

Colorful Fruits and Vegetables

Fruits and vegetables are packed with vitamins, minerals, and antioxidants that help protect the body from cell damage. Berries like blueberries, strawberries, and raspberries are especially rich in antioxidants that support brain and heart health. Leafy greens such as spinach and kale provide essential nutrients like vitamins A, C, and K, along with fiber that supports digestion and cardiovascular health. A simple rule of thumb is to add more color to your plate—each color offers different health benefits.

Healthy Fats That Support the Heart

Not all fats are created equal, and healthy fats play an important role in fighting disease. Fatty fish such as salmon and sardines contain omega-3 fatty acids, which are known to support heart health and help manage inflammation. Plant-based options like walnuts, chia seeds, flaxseeds, and avocados provide similar benefits and are easy to add to meals or snacks.

Whole Grains and Plant Proteins

Whole grains and legumes help fuel the body while supporting stable blood sugar and digestive health. Foods like oats, quinoa, brown rice, beans, and lentils are high in fiber and nutrients that may reduce the risk of heart disease and support weight management. These foods also help you feel full longer, making them a smart choice for everyday meals.

Herbs, Spices, and Gut-Friendly Foods

Small additions can make a big impact. Garlic has long been associated with immune support, while turmeric contains curcumin, a compound known for its anti-inflammatory properties. Fermented foods such as yogurt, kefir, sauerkraut, and kimchi contain probiotics that support gut health—which plays an important role in immunity and overall wellness.

Small Changes, Big Benefits

Healthy eating doesn’t require drastic changes. Simple steps like adding an extra serving of vegetables, choosing whole grains more often, or enjoying fish once or twice a week can support better health over time. When paired with preventive care, good nutrition becomes another powerful way to invest in your well-being.

Eating well should be enjoyable, not stressful. With so many tasty foods that also support your health, fighting disease can begin with something as simple as your next meal.

Medicare Extends Hospital-at-Home and Telehealth Coverage

Tue, 03 Mar 2026 23:07:48 GMT

What It Means for Patients

Recent federal legislation has provided multi-year extensions for two Medicare programs that expanded access to care beyond traditional clinical settings:

the Acute Hospital Care at Home Program (often called Hospital-at-Home) and Medicare telehealth flexibilities . These changes come after prior pandemic-era waivers were set to expire, and they offer more stability for patients and providers alike.

What Was Extended?

Hospital-at-Home through 2030

The Acute Hospital Care at Home Program, which allows certain hospitals to deliver inpatient-level care in a beneficiary’s home, has been extended through September 30, 2030 . This means patients who qualify can continue to receive hospital-level services—such as treatment for infections or recovery support—without being physically admitted to a facility. For many older adults or individuals with mobility challenges, this model can reduce stress, lower risk of hospital-acquired complications, and improve overall comfort during recovery.

Telehealth Flexibilities through 2027

Medicare’s expanded telehealth benefits—originally adopted during the COVID-19 public health emergency—have been extended through December 31, 2027 . These flexibilities include:

Coverage for telehealth services delivered to beneficiaries in their homes
Expanded list of provider types eligible to deliver care virtually
Continued coverage for audio-only telehealth when appropriate
Ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as telehealth distant-site providers

These extensions preserve the ability for beneficiaries to see doctors, specialists, therapists, and other providers using video or phone visits without returning to more restrictive pre-pandemic regulations.

Why These Extensions Matter

Greater Access and Convenience

For Medicare beneficiaries, especially in rural areas or with limited mobility, these extensions mean continued access to care without the need for transportation or in-person visits. Virtual visits have become a lifeline for routine check-ins, chronic condition management, mental health care, and follow-up appointments, often saving time and reducing costs.

Hospital-at-home programs bring a similar advantage for higher-acuity care. Rather than being hospitalized, eligible patients can receive equivalent treatment at home, supported by coordinated medical teams. This model has been shown to offer improvements in patient satisfaction and potentially reduce the risks associated with traditional hospital stays.

Stability After Policy Uncertainty

These extensions come after a period of uncertainty, during which telehealth and hospital-at-home waivers briefly lapsed — and then were reinstated — due to funding and appropriations negotiations in Congress. Long-term extensions give providers important certainty when planning care models and technology investments, and they give beneficiaries reassurance that these expanded care options will continue without abrupt interruptions.

Looking Ahead

Advocates on both sides of the aisle have emphasized the value of telehealth and hospital-at-home services, arguing that they should become permanent parts of the Medicare program. While the recent extensions do not yet make these flexibilities permanent law, they do represent a significant step toward longer-term integration of virtual and in-home care options into the health care system.

This blog is for informational purposes only and reflects federal health policy as of early 2026. Individual coverage can vary based on specific Medicare plans and eligibility.