2026 UPDATES
Key rule changes, rate updates, and policy shifts that affect medical bills, insurance appeals, VA benefits, and Medicare in 2026. Each update links to the relevant Bill Advantage tool.
Priority Group 7 inpatient care: $347.20 plus $2 per day for the first 90 days in a 365-day period. Veterans with a service-connected rating of 10 percent or higher generally pay $0 for related care. The annual medication copay cap remains $700.
VA disability compensation rates were updated with a cost-of-living adjustment. At 70 percent with no dependents: $1,808.45 per month. At 100 percent with no dependents: $3,831.30 per month. Rates increase with dependents.
The FY2026 subsistence allowance for full-time enrollment at the graduate level is $3,439.23 per month. Veterans can elect the GI Bill BAH rate instead if it is higher.
The 2026 DIC base rate for surviving spouses is $1,699.36 per month, tax-free. The SBP-DIC offset was permanently eliminated as of January 1, 2023. Surviving spouses receive both SBP and DIC in full.
A CMS rule effective January 1, 2026 requires payers to decide standard prior authorization requests within 7 calendar days and expedited requests within 72 hours.
The independent dispute resolution process continues to expand in 2026 with a focus on fixing process gaming by high-volume filers. Verify the current IDR portal status at cms.gov before submitting a dispute.
Enhanced premium tax credits from the Inflation Reduction Act expired at the end of 2025. Many enrollees will see higher net premiums in 2026 and may face repayment of excess credits when filing 2026 taxes.
Medicare Part D out-of-pocket costs are capped at $2,000 for 2026 under the Inflation Reduction Act. This is a significant change for enrollees with high drug costs. Verify your plan's current formulary before assuming 2025 coverage continues.
418 new and revised CPT codes took effect January 1, 2026, including expanded codes for AI-assisted diagnostics, remote monitoring, and new diagnostic services. Billing errors tied to newly revised codes are common in the first half of the year.
There is no deadline to file a PACT Act claim. Veterans filing in 2026 receive benefits going forward from their filing date. Veterans denied before 2022 for a condition now on the presumptive list can file a Supplemental Claim without a nexus letter.
See all 32 tools
Medical, dental, vision, pharmacy, VA benefits, and healthcare financial planning.
Browse all tools