Heart failure and chronic obstructive pulmonary disease will join three other conditions covered by Medicare’s ACCESS Model starting in spring 2027, the Centers for Medicare & Medicaid Services said Sept. 15, expanding a program that already reaches roughly three out of four people with Medicare. The model pays participating organizations for measurable health improvements rather than for individual services, a structural bet that outcomes-based Medicare payment can reach patients between doctor visits. Because ACCESS runs only inside Original Medicare, the expansion draws a sharp line for beneficiaries enrolled in Medicare Advantage instead.
The Five New Tracks Starting In Spring 2027
CMS’s press release lists five specific additions rolling out under the ACCESS Model next spring: continuous monitoring for heart failure focused on symptom management and quality of life; targeted support for chronic obstructive pulmonary disease aimed at maintaining lung function and easing symptoms; comprehensive care for substance use disorders, including integrated support for co-occurring depression and anxiety tied to the administration’s Great American Recovery initiative; assistance with tobacco cessation; and extended support for chronic musculoskeletal pain beyond the model’s initial 12-month care period.
Each track lets a participating organization deliver virtual care, health coaching, remote monitoring and connected devices between a beneficiary’s regular office visits, with primary care providers referring patients into whichever track matches their diagnosis. Participation is voluntary, and CMS states plainly that joining a track does not change a beneficiary’s Medicare benefits, coverage or choice of provider. The agency is expanding the roster of participating organizations from 160 at launch, and says it will keep adding organizations throughout the model’s ten-year run, which CMS documents show began its performance period in 2026.
The expansion builds on an ACCESS Model that already covers high blood pressure, diabetes, chronic musculoskeletal pain and depression, and CMS credits those four existing tracks with reaching three out of four people with Medicare today, before the new heart-failure, COPD, substance-use-disorder, tobacco-cessation and expanded-musculoskeletal additions take effect. That baseline number matters because it sets the scale CMS is building on: a program already large enough to touch most Original Medicare enrollees is now layering five more chronic-condition entry points onto the same outcomes-based payment structure.
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Why Medicare Advantage Enrollees Are Excluded
ACCESS supports people with Original Medicare only; CMS’s press release states plainly that Medicare Advantage enrollees are not eligible, though their private plans may offer similar programs of their own design. That exclusion reflects how the model is built: ACCESS operates as a CMS Innovation Center demonstration tied to fee-for-service claims data and direct payment to participating organizations, a mechanism that does not fit inside Medicare Advantage’s capitated payment arrangements, where insurers rather than CMS control provider payment. A beneficiary enrolled in a Medicare Advantage plan cannot reach the new heart-failure or COPD tracks through ACCESS itself and would need to ask that plan directly whether it runs a comparable chronic-care benefit.
CMS is also enlisting the private insurance market around the same payment model without extending ACCESS itself to Medicare Advantage: major health payers covering more than 165 million Americans across Medicare Advantage, Medicaid and private insurance have pledged to adopt an outcomes-based payment structure aligned to ACCESS, with participating insurers agreeing to align supported programs by January 1, 2028. Signatories named on CMS’s pledge page include UnitedHealthcare, Humana, Cigna, CVS Health and Centene, among more than a dozen other regional and national plans. That pledge does not make the new heart-failure, COPD or substance-use tracks available inside Medicare Advantage, but it signals that comparable outcomes-based chronic-care programs could reach MA enrollees through their own plans well before ACCESS itself expands beyond Original Medicare, if it ever does.
CMS directs beneficiaries with questions about ACCESS eligibility to call 1-800-MEDICARE or consult the model’s own directory of participating organizations and covered conditions. Eighteen clinical and patient societies have also expressed support for CMS’s effort to expand technology-supported chronic care, a detail the agency included in the same Sept. 15 release announcing the new tracks.
The Outcomes-Based Payment Behind The Expansion
The ACCESS Model, which CMS’s own program page describes as testing an outcome-aligned payment approach in Original Medicare, ties payment directly to measurable improvements in a patient’s health rather than reimbursing for individual services rendered. The agency says 160 organizations are participating at launch, with more added over what CMS’s own materials describe as a ten-year performance period. CMS’s Innovation Center — the office responsible for testing new Medicare payment models — designed ACCESS to sit inside Original Medicare’s existing claims infrastructure, which is why the payment mechanism cannot simply be transplanted into Medicare Advantage’s plan-level contracts without payers separately adopting it, as the pledge signatories have chosen to do.
CMS Administrator Dr. Mehmet Oz framed the expansion as closing a gap in ongoing care, saying the agency built ACCESS “because too many people with chronic conditions were falling through the cracks between appointments.” Oz described the technology-supported approach — remote monitoring, connected devices and virtual coaching between office visits — as a way to give patients and providers “greater access to AI-enabled technologies” and to “reward providers who deliver actual results,” rather than paying for volume of services regardless of outcome.
CMS’s Sept. 15 release leaves the roll-out details to the model’s directory, which will list which of the 160 launch organizations offer each new track once heart-failure, COPD, substance-use-disorder, tobacco-cessation and extended-musculoskeletal support activate in spring 2027. Until then, the agency’s own numbers remain the clearest evidence of scale: three out of four people with Medicare already qualify for an existing ACCESS track, a base the five new additions are built to expand rather than replace.
New Benefits and the Cost Side of Them
The ACCESS expansion changes what care options exist for heart failure, COPD and other chronic conditions, but it does not touch the premiums, prior-authorization rules or drug costs that come with managing those same conditions inside Original Medicare. Enrollees weighing whether an ACCESS track fits their situation are left to track Part D out-of-pocket costs, appeal a denied prior authorization, or compare state-level cost-help programs entirely on their own, often without a single place that lays out the current rules side by side. Those gaps sit outside CMS’s press release entirely, in the paperwork and deadlines that follow a chronic-condition diagnosis.
The Medicare Cost & Coverage Protection Kit is a 10-page kit paired with a medication and cost tracker for keeping every prescription, premium and appeal deadline in one place.
Open the medication and cost tracker in The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
