Compulsory medical insurance in 2026: what will become available for free

In 2026, Russia will continue to implement the compulsory medical insurance (CHI) program, which provides citizens with free access to a wide range of medical services. According to the approved regulations, the list of free CHI operations will include both standard interventions and new types of surgical treatment based on modern medical technologies. For more information, see the Izvestia article.

The standard list of free compulsory medical insurance operations

Under the compulsory medical insurance (CHI) program, Russian citizens have the right to perform various types of operations free of charge. These include elective surgical procedures such as appendix removal, cholecystectomy, and hernia surgeries that do not require emergency intervention. Emergency operations are also provided for life-threatening conditions, such as peritonitis, trauma, or acute bleeding.

In addition, oncology operations are available within the framework of compulsory medical insurance, including the removal of tumors of various localizations, such as breast, lung, stomach and other cancers. The list also includes orthopedic surgeries such as joint replacement, deformity correction, and treatment of fractures and dislocations. Gynecological interventions, including uterine removal, myomectomy, and infertility surgery, are also provided free of charge.

In addition, citizens can count on free cardiac surgery, such as bypass surgery, pacemaker installation and heart valve surgery, as well as neurosurgery, including removal of brain and spinal cord tumors and treatment of injuries to the nervous system. All these operations are performed in state and municipal medical institutions that have the appropriate license and accreditation.

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Nadezhda Kapustina, Professor of the Department of Economic Security and Risk Management at the Financial University under the Government of the Russian Federation, told what else the compulsory medical insurance program implies.

"We are also talking about such breakthrough areas as targeted cancer therapy, which allows us to target specific molecular targets of cancer cells, as well as expanding the use of robotic surgical systems that ensure maximum precision of interventions with minimal tissue injury. Although gene therapy remains on the periphery of mass adoption due to the high cost and the need for additional regulatory framework, it is gradually approaching inclusion in the program," Nadezhda Kapustina shared.

New types of operations included in the compulsory medical insurance in 2026

In 2026, the list of free CHI operations will include new types of surgical intervention that meet modern medical standards. As part of the CHI program, modern methods such as valve replacement in cardiovascular surgery, reconstructive surgery for injuries, as well as organ-preserving interventions using robotic technologies on the pancreas, liver, bile ducts, esophagus, stomach and intestines will be available.

In addition, under the compulsory medical insurance policy, patients will be able to use unique and expensive technologies to restore their health, such as implantation of a frequency-adjusted pacemaker and endovascular destruction of additional pathways and arrhythmogenic zones of the heart.

Nadezhda Kapustina added that the medical examination in 2026 involves the inclusion of additional diagnostic tests. Special attention is paid to oncological markers, studies on predisposition to cardiovascular pathologies and metabolic disorders.

"The proposed innovations will make it possible to detect diseases at preclinical stages, when therapeutic intervention is most effective and economically justified in terms of long—term costs of the healthcare system," the expert said.

The procedure for obtaining a free compulsory medical insurance operation

To receive a free CHI operation, the patient must first contact a therapist or a specialized specialist who will provide a referral for examination and consultation. After that, it is necessary to undergo all the necessary examinations, take tests, undergo instrumental studies and receive expert opinions.

If the operation is indicated, the doctor will issue a referral to the appropriate medical institution, where the patient will undergo the operation in accordance with the established procedure. It is important to note that all stages of treatment, including diagnosis, surgery, and postoperative follow-up, should be free of charge and provided under the compulsory medical insurance program.

As Nadezhda Kapustina noted, the most acute problem of expanding the compulsory medical insurance program remains the unjustified refusal of insurance medical organizations to pay for complex surgical procedures, motivated by formal grounds.

— Patients regularly encounter situations where insurers cite a lack of medical indications, non-compliance with clinical recommendations, or exceeding hospital admission standards. The situation is gradually changing due to increased control by the Federal Compulsory Health Insurance Fund and the introduction of more transparent criteria for examining the quality of medical care," Kapustina added.

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With regard to dental care in a hospital setting, it is formally covered by insurance only if there are emergency indications or as part of the comprehensive treatment of maxillofacial injuries and congenital anomalies. However, planned interventions remain outside the basic program, which creates legal uncertainty for patients with combined pathology requiring simultaneous solution of dental and surgical problems. Reconstructive surgeries after burns, injuries, or oncological resections balance between medical necessity and cosmetic surgery, Kapustina emphasized.

— The regulation of such borderline cases is gradually being improved through the development of detailed clinical guidelines and patient routing. However, law enforcement practice remains heterogeneous in different regions, which requires further unification of approaches and improving the legal literacy of both medical professionals and patients themselves," the expert shared.

Financing and accessibility

In 2026, the financing of the compulsory health insurance program will be increased, which will expand the list of available medical services and improve the quality of care. Special attention will be paid to the modernization of medical equipment, training of medical personnel and improving the infrastructure of medical institutions.

According to Nadezhda Kapustina, the list of drugs available to privileged categories of citizens will be replenished with modern expensive drugs, including innovative immunotherapeutic drugs and targeted medicines of the latest generation.

— Inpatient drug provision is becoming more flexible, providing for the possibility of using personalized therapy regimens. This is especially true for oncological and hematological patients. The outpatient unit receives expanded powers to prescribe drugs previously available exclusively in a hospital setting,— Kapustina shared.

In addition, it is planned to expand the network of medical institutions participating in the compulsory health insurance program, especially in remote and rural areas, in order to ensure equal access to quality medical care for all citizens.