Two major Medicare developments emerged this week that every beneficiary should be aware of. First, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 Physician Fee Schedule, a massive rule determining how doctors and clinicians will be paid next year. At nearly the same time, the federal government shutdown abruptly disrupted telehealth access for millions of seniors who had come to rely on virtual visits since the pandemic.
While these stories might seem unrelated, together they reveal a critical truth about Medicare in 2025–2026: the system is under stress, and how it pays providers—and what it covers—directly affects how and where beneficiaries receive care.
Here's what's changing, why it matters, and what you can do to stay ahead of it.
The 2026 Physician Fee Schedule — What Changed
In late October, CMS released its final rule for the 2026 Physician Fee Schedule (PFS). This rule outlines how Medicare will reimburse doctors, specialists, and other clinicians for the services they provide to beneficiaries starting January 1, 2026.
Key takeaways:
- Two new conversion factors: Providers participating in a "Qualified Alternative Payment Model" (APM) will see a +3.77% increase over 2025. Non-APM clinicians will see a +3.26% increase.
- Efficiency adjustment: CMS added a -2.5% reduction for some non-time-based services where technology or workflow improvements have reduced costs.
- Broader payment structure updates: Changes to practice-expense calculations, the Shared Savings Program, and evaluation of telehealth and remote monitoring codes.
At first glance, these updates might sound like accounting jargon—but they have real implications for seniors.
Why This Matters to You
Access to care
When payments to doctors stagnate or fall behind inflation, some providers limit or stop taking new Medicare patients. Modest increases, like those for 2026, may help keep more physicians in the system—but efficiency cuts could offset that progress in certain specialties.
Ripple effects across plans
These changes directly affect Original Medicare, but the private plans built on top of it—Medicare Advantage and Medigap—follow closely. If fewer physicians participate in Original Medicare, Advantage networks may tighten, too.
Future sustainability
The rule highlights Medicare's ongoing push toward value-based care—rewarding providers for quality and efficiency rather than volume. For beneficiaries, that can mean more coordinated care but also potential shifts in which services are prioritized.
What to ask your provider:
- "Are you still accepting Medicare in 2026?"
- "Will your office's telehealth or home-visit options change next year?"
- "If you're part of a new payment model, will that affect how often I can see you?"
Understanding these shifts early helps you plan your 2026 coverage choices and avoid surprise access issues down the road.
Telehealth Disruptions Amid the Federal Shutdown
While the fee schedule shapes 2026's long-term landscape, the federal government shutdown has already created immediate challenges for beneficiaries who depend on telehealth.
When temporary telehealth flexibilities introduced during the COVID-19 pandemic expired on September 30, 2025, Congress had been expected to extend them. But the shutdown halted that process, freezing key appropriations and guidance needed to keep the expanded coverage in place.
The result: millions of seniors lost access to home-based telehealth overnight.
What's Changed
- For Original Medicare: Telehealth is once again limited mainly to rural patients or those visiting specific medical facilities. Home-based video visits are largely no longer covered.
- For many providers: Payment uncertainty forced them to pause or cancel Medicare telehealth appointments. Some have shifted patients back to in-person care only.
- For "Hospital at Home" programs: CMS' "Acute Hospital Care at Home" waivers, which allowed hospitals to treat certain patients in their homes, have been temporarily suspended.
These changes are already being felt nationwide. A speech therapist in Illinois reported stopping virtual sessions for Medicare clients, and mental-health providers in several states have suspended video therapy.
Why This Matters to Seniors
During the pandemic, telehealth became a lifeline—especially for those with mobility challenges, chronic illness, or transportation barriers. The shutdown has reversed years of progress in just days.
- Access challenges: Seniors may need to travel longer distances to receive care they previously accessed at home.
- Financial strain: Without telehealth coverage, some beneficiaries may have to pay out-of-pocket or postpone care.
- Confusion: Because rules differ between Original Medicare and Advantage plans, many beneficiaries are unsure whether their telehealth visits are still covered.
What you can do:
- Call your provider's office: Confirm whether telehealth appointments are still available for Medicare patients and whether you'll be billed.
- Check your plan documents: If you're on a Medicare Advantage plan, review your 2025–2026 Evidence of Coverage. Many Advantage plans continue offering telehealth benefits even if Original Medicare pauses them.
- Ask about alternatives: Some community health systems offer phone-based visits or home-visit options to bridge gaps during the shutdown.
Related Medicare Updates
How These Two Developments Intersect
Together, these stories tell a deeper story about Medicare's future.
Medicare is balancing three competing priorities: keeping costs down, paying providers fairly, and ensuring access for beneficiaries. Payment reforms (like the 2026 rule) aim to sustain the program financially, but disruptions (like the shutdown) highlight how fragile that balance can be.
When provider payments lag, access suffers. When telehealth coverage disappears, beneficiaries lose flexibility. And when both happen close together—as they did this fall—seniors are left uncertain about how, where, and even if they can receive care.
This is precisely where clear information and planning matter most.
What You Should Do Now
Here's a step-by-step guide to help Medicare beneficiaries protect their care during this transition:
1. Review your coverage
- Visit Medicare.gov to confirm which services (including telehealth) are covered under your plan type.
- If you use a Medicare Advantage plan, call the customer service number on your member card to verify telehealth benefits.
2. Talk to your providers
- Ask whether your doctors anticipate any network or payment changes for 2026.
- If telehealth has been paused, ask if it may resume after funding is restored.
3. Consider your access needs for 2026
- Do you rely heavily on telehealth or home-care? If so, weigh plans that specifically include these benefits.
- During the upcoming Annual Enrollment Period, prioritize plans that maintain flexibility and access for your personal situation.
4. Stay informed
- Sign up for trusted updates from CMS or from GentleMedicareGuide.com.
- Bookmark our Medicare 101 hub for updates as Congress works toward restoring full telehealth access.
✅What This Means for You
Between the 2026 physician payment reforms and the temporary rollback of telehealth coverage, the coming year will test Medicare's ability to balance innovation with accessibility.
For beneficiaries, the key is preparation—understanding how these changes may affect your doctors, your costs, and your convenience. Whether you're already enrolled or approaching age 65, now is the time to review your coverage, confirm your provider's participation, and explore your options before the 2026 enrollment cycle.
Gentle Medicare Guide will continue to track both stories and provide updates as CMS and Congress clarify the next steps.
Explore Further
Stay Informed
Bookmark GentleMedicareGuide.com/news for daily Medicare insights, or explore our Medicare 101 hub for foundational guides.
Take our Find Your Medicare Path Quiz to get a personalized plan roadmap for 2026.
