Medicare Advantage will officially drop these benefits in 2026

Medicare Advantage is about to look very different in 2026, and not in ways most enrollees will welcome. Federal regulators are tightening the definition of what counts as a health-related benefit, and insurers are responding by cutting back some of the extras that helped these plans stand out from traditional Medicare. The result is that several popular perks will disappear or shrink next year, even as drug protections improve and overall plan costs stay relatively stable.

For anyone who has come to rely on grocery cards, transportation help, or other lifestyle benefits, the stakes are real. The new rules do not just trim around the edges, they formally declare that certain items will no longer qualify for coverage at all, especially under Special Supplemental Benefits for the Chronically Ill, or SSBCI. Understanding exactly what is being dropped, and why, is the first step to avoiding unpleasant surprises when 2026 enrollment opens.

Why Medicare Advantage extras are on the chopping block

The generous add-ons that have defined many Medicare Advantage plans did not appear by accident. Earlier policy changes, including provisions in Bipartisan Budget Act 2018, gave insurers room to offer a wider range of supplemental benefits that were not strictly medical, such as help with meals or home supports. Those flexibilities helped fuel a race to pile on perks, from grocery allowances to transportation vouchers, as plans competed for enrollment. By 2025, many enrollees had come to see these extras as a core part of their coverage, even though they were never guaranteed in the way hospital or doctor benefits are.

Heading into 2026, regulators and insurers are recalibrating that balance. Federal rules are narrowing what counts as “primarily health related,” and companies are reassessing which benefits they can afford to keep while still meeting new requirements on drug spending and consumer protections. Analysts tracking Medicare Advantage trends for 2026 note that while many plans with Part D prescription drug coverage are holding premiums steady, they are also trimming back some of the more generous supplemental offerings to make the math work. In other words, the headline price may not rise much, but the underlying package is changing.

SSBCI benefits face strict new limits

The most dramatic shift arrives in the niche but important category of Special Supplemental Benefits for the Chronically Ill. SSBCI was designed to let Medicare Advantage plans tailor extra services to people with serious, ongoing conditions, even if those services were not traditional medical care. Starting in 2026, that flexibility is being sharply curtailed. Federal guidance now makes clear that SSBCI services do not have to be primarily health related, but they must still be reasonably expected to improve or maintain the health or overall function of a chronically ill enrollee, and anything outside that scope will be excluded. Reporting on Special Supplemental Benefits underscores that this standard will now be enforced more tightly, closing the door on some of the more creative uses of SSBCI dollars.

At the same time, there is a separate financial cap that directly affects these benefits. Analysts tracking 2026 rules highlight a new Limit on SSBCI spending in Medicare Advantage, which reduces the maximum amount plans can devote to these special supplements from $9,350 in 2025 to $9,250 in 2026. It is unusual to see a hard ceiling placed on this kind of targeted support, and the combination of a lower cap and a stricter definition of what qualifies means some services that were available to chronically ill members in 2025 will simply not be offered in 2026. For enrollees who depended on those supports to stay stable at home, that is not a minor tweak, it is a meaningful loss.

Nonmedical perks that will no longer qualify

Beyond SSBCI, regulators have drawn a bright line around a broader set of nonmedical benefits that Medicare Advantage plans will not be allowed to count as primarily health related at all. In the Final Rule, Final Rule, CMS adopted a non-exhaustive list of items and services that do not meet the standard of improving or maintaining the health or overall function of the enrollee. That list includes things like general-purpose gift cards, entertainment subscriptions, and other lifestyle extras that might make life more pleasant but are not tied to a specific health outcome. Once these are formally categorized as non-qualifying, plans can no longer market them as covered benefits under the Medicare Advantage umbrella.

The practical effect is that some of the flashiest perks that drew attention in recent years will disappear from plan brochures. Earlier marketing cycles featured cards that could be used for a wide range of purchases, including unhealthy foods, as well as memberships and services that were only loosely connected to medical care. Regulators are now signaling that such broad, non-targeted benefits are out of bounds for Medicare Advantage funding, a shift that aligns with the tighter definitions that followed Bipartisan Budget Act 2018’s initial expansion. For consumers, the message is clear: if a perk does not have a direct, documented link to your health or function, do not count on it being there in 2026.

Gym memberships, dental extras, and other scaled-back benefits

Even among benefits that still qualify as health related, insurers are trimming. Several reports on 2026 plan designs point to a pullback in some of the most visible extras, including fitness programs, expanded dental coverage, and hearing services. One analysis notes that Extra benefits are being scaled back, with several perks Medicare Advantage plans offered, like gym memberships and broader dental or hearing coverage, becoming less generous or disappearing from certain plan options. For someone who joined a plan largely because it included a SilverSneakers-style membership or comprehensive dentures, that change can feel like a broken promise, even if the core medical coverage remains intact.

Insurers are not cutting these benefits in a vacuum. They are juggling new drug cost protections, evolving risk adjustment rules, and pressure to keep premiums attractive. A detailed look at 2026 offerings shows that while Key Takeaways include the fact that many of your monthly and annual costs are projected to rise, average Medicare Advantage and Part D premiums are not expected to spike dramatically. To make that possible, plans are quietly paring back the add-ons that are not strictly required. The trade-off is subtle but important: the sticker price looks stable, yet the value of what you get for that price is shifting.

Drug savings grow while lifestyle benefits shrink

One reason supplemental benefits are under pressure is that drug protections are getting stronger, and those improvements cost money. Starting in 2025, Medicare capped annual out-of-pocket spending on Part D drugs, and that cap is being refined in 2026. A breakdown of the new rules notes that Major Drug Savings to stay and grow, with a clear table of Drug Cost Rule limits and what they mean for enrollees. Those protections are a lifeline for people facing high-cost medications, but they also compress the margins that Medicare Advantage plans have traditionally used to fund extras.

As insurers evaluate profitability, they are making hard choices about where to cut. Analysts observing Medicare Advantage Highlights 2026 point out that Two thirds of all Medicare Advantage plans with Part D prescription drug coverage are keeping premiums at $10 or less per month, which is politically and commercially attractive but leaves little room for lavish supplemental benefits. In that environment, lifestyle perks that are nice to have but not essential to medical care are the first to go. The upside is more predictable drug costs, but the downside is a leaner package of nonmedical support.

Supporting sources: Medicare Advantage Changes.