LUGPA Policy Update: 2026 Medicare Cost-Sharing Increases and Implications for Independent Urology Practices

December 2025

On November 14, 2025, CMS released the 2026 Medicare cost-sharing amounts. Virtually all beneficiary cost-sharing obligations are increasing, most notably Part B premiums and deductibles, but also Part A hospital deductibles, coinsurance amounts, and skilled nursing facility (SNF) copayments. These across-the-board increases are driven by projected price inflation and higher anticipated service utilization.

While the exact dollar impact varies by beneficiary (especially for higher-income individuals subject to Income-Related Monthly Adjustment Amounts, or IRMAA), the clear trend is higher out-of-pocket costs in 2026 for many Medicare patients.

Implications for Independent Urology Practices

Patient Affordability and Utilization

Higher Medicare cost-sharing is likely to create financial pressure for patients, particularly in the early months of the year when deductibles reset. Practices may see:

• Delays or deferrals of elective procedures, surveillance visits, and diagnostic testing
• Increased patient sensitivity to out-of-pocket estimates
• Potential reduction in overall visit and procedure volume, especially among cost-conscious beneficiaries

Practice Operations and Communications

• Billing systems, fee schedules, patient education materials, and financial counseling scripts will need prompt updates
• Front-office and billing staff should be prepared for more questions about 2026 cost-sharing responsibilities
• Proactive, clear communication about expected patient responsibility can reduce surprise bills, no-shows, and accounts receivable delays

Care Coordination for Surgical and Post-Acute Patients

Rising Part A hospital deductibles and SNF coinsurance may influence discharge planning and patient acceptance of recommended post-operative rehabilitation. Closer collaboration with hospitalists, case managers, and SNF partners will be important to align clinical and financial expectations.

Financial Management and Planning

• Expect greater variability in collections and a possible increase in requests for payment plans or charity care
• Early-year cash flow may be affected as patients meet higher deductibles
• Practices should incorporate these cost-sharing trends into 2026 budgeting, staffing plans, and productivity forecasts

Recommendations for Independent Urology Practices

1. Train Staff Early – Ensure front-desk, billing, and clinical teams understand the general direction and magnitude of 2026 cost-sharing increases and can explain them confidently to patients.
2. Update Patient-Facing Materials – Revise financial policy handouts, new-patient packets, and website FAQs to reflect higher out-of-pocket exposure.
3. Strengthen Financial Counseling – Provide accurate, user-friendly estimates at the time of scheduling, particularly for deductible-status patients and elective cases.
4. Monitor Key Metrics in Q1 2026 – Track no-show rates, cancellation rates, procedure deferrals, and collection rates to quantify the real-world impact and adjust staffing or outreach as needed.
5. Engage Hospital and SNF Partners – Confirm that discharge planners and post-acute facilities are also educating patients about the higher 2026 Part A and SNF cost-sharing amounts.

By anticipating these cost-sharing pressures now, independent urology practices can mitigate disruptions to patient access, revenue cycle performance, and overall operational efficiency in 2026.