Starting January 1, 2026, the massive changes to Medicare will affect Medicare beneficiaries with chronic wounds across the United States. The total population of Medicare beneficiaries with chronic wounds numbers approximately 10.5 million, all of whom could experience impacts from these policy changes. Patients who depend on timely intervention to prevent complications and preserve quality of life face potential challenges from this shift.
What Are the Changes To Medicare?
In an October 31st press release, CMS detailed the Medicare reimbursement limits for Cellular and Tissue-Based Products to a select approved list, potentially leaving numerous products non-covered. These restrictions create risk of reimbursement denials and care disruption for patients whose providers use non-covered products or fail to meet stringent documentation standards. The narrowed formulary adds to existing barriers, making it harder for beneficiaries to receive the skin substitute grafts that have become standard in treating diabetic foot ulcers, venous leg ulcers, and pressure sores.
According to the CMS press release, the rules have been changed because spending on wound care products known as "skin substitutes" has had unprecedented growth, rising from $256 million in 2019 to over $10 billion in 2024, they further allege fraud as a reason for these new rules.
Ask Kenton Gray why these changes are harmful to Medicare beneficiaries and what should have been done instead.
Expert Concerns About Patient Care
Kenton Gray questions the new Medicare fee schedule. He comments, "Medicare's decision to slash wound care reimbursements by 90% is a dangerous, short-sighted policy that puts as many as 10.5 million Americans at risk. By focusing solely on immediate cost savings while ignoring the devastating long-term consequences, increased amputations, preventable deaths, and ultimately higher healthcare costs, Medicare has made a decision that will harm the most vulnerable patients."
Gray quotes Health and Human Services Secretary Robert F. Kennedy, Jr., "The new Medicare fee schedule delivers a major win for seniors, protects hometown doctors, and safeguards American taxpayers, it realigns doctor incentives and helps move the country from a sick-care system to a true health care system," and questions the efficacy of the statement.
The Reality for Seniors
Gray's reality is bleaker: Seniors will lose reasonable access to wound care treatment under the new rules as doctors step back from providing care they can no longer afford to deliver and clinics close their doors.
Gray predicts downstream effects of wound care patients not being treated. It's why Medicare added advanced wound care to the system in 2017. The number of visits to doctor's offices, urgent care clinics, and hospitals were multiplying. People were constantly looking for treatment for their chronic wounds. Costs were escalating. Wounds weren't healing, leading to amputation. Amputation never really heals. Either the person dies, or they get multiple amputations before they die. So that's what we may be looking at again.
Diabetes Prevention Concerns
"It's admirable that a Medicare Diabetes Prevention Program including coaching, peer support, and training in dietary change, physical activity and behavior change strategies has been approved for people with prediabetes, at no cost to beneficiaries," Gray commented, "but what about those who have diabetes now? How does this protect those seniors?"
Have all the stakeholders been considered and treated fairly? There are economic conditions ... financial conditions for doctors, the cost of treating wound care patients ... and there's the patient condition, will they be able to pay for treatment even if they can find a doctor or clinic? It appears that not all viewpoints were considered.
What Wound Care Patients Can Do
What can wound care patients do? Gray strongly suggests seeking wound care treatment now before it's too late, before the new rules come into effect on January 1, 2026.
KureCare, a division of Veracor Group LLC, offers treatments that the company reports are Medicare-covered for 95% of qualified patients. According to the company, their regenerative medicine approach delivers faster healing times compared to traditional methods. By focusing on evidence-based protocols and streamlined documentation, staff at KureCare work to reduce the administrative burden that often slows access to care.
Nationwide Provider Network
With a nationwide network of 500+ certified wound care specialists, KureCare reduces barriers to accessing covered regenerative treatments. The provider footprint addresses the narrow network challenges that many Medicare beneficiaries face, helping patients find qualified specialists in their area without lengthy referral processes or travel. The company's infrastructure is designed to support rapid treatment initiation, even as regulatory requirements become more complex.
Conditions Treated
The three primary chronic wound types affected by the January 1, 2026, policies are diabetic foot ulcers, venous leg ulcers, and pressure wounds. These are the conditions KureCare's treatments address most often. Patient testimonials illustrate potential outcomes: Margaret T's diabetic foot ulcer healed in six weeks after eight months of traditional treatment with no progress, while Robert M and Linda C experienced recoveries from venous leg ulcers and pressure wounds, respectively. Individual results may vary, but these anecdotal examples demonstrate that timely access to regenerative therapies can improve prognoses.
Check Your Eligibility Now
Medicare beneficiaries with chronic wounds are advised to check KureCare eligibility now to understand their coverage options before the new policies take effect. Proactive assessment allows patients to secure treatment plans and provider relationships ahead of January 1, 2026, protecting against potential disruptions. The company's quick eligibility quiz provides immediate clarity on coverage status, enabling informed decision-making during this period of policy transition.
Don’t delay, the clock is ticking.
Get your wound assessed today!
#medicare#wound care#chronic wounds#healthcare policy#2026 changes
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