Payer Updates | A Gift for you!

In the spirit of the season, we’re extending a limited-time “member-style” benefit to everyone, so you can access the same practice finance tools our members use to stay ahead of 2026 payer updates.

 

Below are three important payer updates to note for 2026!

Medicare Advantage (MA) Changes for 2026

It is that time of year when your Medicare patients will be making decisions with regard to their coverage for 2026. Unlike years prior, Medicare beneficiaries will have less options when it comes to Medicare Advantage plans. Although not yet confirmed, it appears Anthem, UHC and Aetna are drastically reducing their Medicare Advantage plans. It has been reported that UCare in Minnesota will terminate its MA plans for 2026. UHC may be dropping plans that will impact over 600,000 members. And Aetna may close about 90 plans.  Carriers are focused on no longer offering the PPO plans due to higher healthcare costs and movement toward more cost-effective offerings.

What does this payer update mean for you and your patients?

If the PPO plans are no longer available, the patient may switch back to Traditional Medicare or enroll in a HMO plan. If they choose an HMO plan, keep in mind that it is a managed plan and will have more restrictions with regard to networks, services, and possible pre-authorization requirements.

You can avoid the frustration and heavy workload by being proactive.

Log into the payer sites and locate the provider manuals, reimbursement guidelines, coding edit tools and pre-authorization requirements for these major payers. Review these documents and create billing policies and training for your staff in the month of December. This way, when January comes around, your team members will be equipped to identify these plans and implement a solid verification process. Your patients will appreciate knowledgeable staff who can guide them through their chiropractic coverage and benefits.

KMC University Members can check out the online resources in the Practice Finances section of KMC University library titled How Insurance Works & Insurance Verification.

---

VA Fee Schedule Released

If you render treatment to VA patients, the new fee schedule has been posted.

You can find it at: https://www.va.gov/COMMUNITYCARE/revenue-ops/Fee-Schedule.asp

Not sure how to navigate the world of VA Community Care?

Make it a goal this year to be a part of the community of chiropractors treating Veterans. Learn more at: https://www.va.gov/COMMUNITYCARE/providers/Community-Care-Network.asp

KMC University offers additional training for our members in our Practice Finances section of the learning library under How Insurance Works. Sign into your library, return to this notice,  and click on the following link: https://learn.kmcuniversity.com/courses/how-insurance-works/lessons/va-health-care-coverage/

The reactive approach can be costly

Payer updates will be rolling out over the next few weeks. It is vital that your team take the proactive approach to billing for services rendered in the clinic. The reactive approach can be costly. Keep your reimbursement machine running efficiently by locating the fee schedules and policy changes for all your participating plans.

---

Medicare Part B Deductible for 2026

To ensure clean claims and smooth payment processing, keep your billing software and fee schedules current. Medicare has announced the 2026 Part B annual deductible: $283, up from $257 in 2025.

Please update your systems and train staff on this change and any related updates impacting patient collections.

https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles

---

Don’t wait for denials to tell you what has changed.

A proactive December protects your time, your reimbursements, and your patients’ experience.

Next steps (do this in December):

1. Confirm your top payers’ 2026 plan changes and requirements,
2. Download updated fee schedules/policies (including VA),
3. Update your software (Medicare Part B deductible is $283 for 2026, up from $257 in 2025), and retrain staff on collections and verification workflows. Centers for Medicare & Medicaid Services
   A proactive December prevents January chaos—let’s keep your reimbursement machine running smoothly.

Wondering what applies to your clinic?

Schedule a FREE Discovery Assessment and we’ll help you choose the right path—pinpointing the highest-impact updates for your practice and mapping next steps to get your systems and team ready for January.