Since July 5, 2026, Medicare has been running a ten-year test of a new way to pay for chronic-disease care called ACCESS, and the newly printed Medicare & You 2027 handbook is the first place most enrollees will see the name. Before that date, doctors treating hypertension, diabetes, chronic musculoskeletal pain or depression under Original Medicare had no payment option built around the technology many now use to track those conditions. After it, participating organizations can bill Medicare differently, with the government tying payment to whether a patient’s numbers actually improve rather than how many visits occurred.
How the Outcome-Aligned Payment Actually Works
CMS built ACCESS to close a gap in fee-for-service Medicare, which pays doctors for a defined list of billable activities regardless of whether a patient’s underlying condition changes. The model instead tests what CMS calls an Outcome-Aligned Payment: a recurring payment to a Medicare-enrolled care organization for managing a patient’s qualifying chronic condition, with full payment released only when the organization hits a measurable clinical target. CMS’s own example is a patient with hypertension lowering blood pressure by 15 millimeters of mercury, a specific, verifiable number rather than a completed appointment.
CMS describes ACCESS as a model that tests an outcome-aligned payment approach in Original Medicare to expand access to technology-supported care, built to reward outcomes instead of the volume of services delivered. That structure is meant to give clinicians room to use remote monitoring, wearables, coaching and medication management instead of relying only on in-person visits, and CMS ties the entire payment, not a bonus on top of it, to whether those tools actually move a patient’s numbers.
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Which Conditions Qualify and How Organizations Enter the Model
The ACCESS Model launched on July 5, 2026, and CMS set it to run for ten years, one of the longest single tests currently active inside the CMS Innovation Center. More than 150 health care organizations have been accepted to participate in the launch, according to CMS’s own applicant list, last updated August 17, 2026. Participation is voluntary on both sides: an accepted organization decides whether to offer the technology-supported track, and a Medicare beneficiary can decline a referral into it without affecting any other Medicare benefit.
Four groups of conditions qualify at launch: high blood pressure, diabetes, chronic musculoskeletal pain, and a behavioral health track covering depression and anxiety, a set CMS says affects more than two-thirds of people with Medicare. A primary care doctor can refer a patient into a participating organization, then separately bill Medicare for reviewing and coordinating that patient’s progress, so the model layers onto an existing physician relationship rather than replacing it.
Every participating organization must enroll in Medicare Part B as a provider or supplier and name a physician Clinical Director responsible for clinical quality and compliance, under CMS’s technical rules for the model. CMS says ACCESS is designed to complement Accountable Care Organizations and other shared-savings arrangements rather than compete with them; the agency expects no effect on ACO benchmark or performance-year calculations for the Medicare Shared Savings Program or ACO REACH during 2026 or 2027, while it builds the systems those calculations will eventually need.
ACCESS is being tested only inside Original Medicare, not Medicare Advantage. CMS’s rules note that Medicare Advantage organizations may independently adopt similar outcome-based payment arrangements with their own contracted providers, but any such private arrangement sits entirely outside this federal model and its ten-year evaluation. That distinction matters for anyone weighing Original Medicare against a Medicare Advantage plan, since a referral into ACCESS itself currently runs only through the traditional program.
What Changes for a Beneficiary’s Costs, and What Still Doesn’t
CMS’s own rules for the model answer the beneficiary-cost question directly: participating in ACCESS does not change Medicare benefits, coverage, or rights, and an enrollee keeps every standard Medicare protection and the ability to see any Medicare provider. That is a narrower promise than the framing many beneficiaries will meet first, since the same agency’s Medicare & You 2027 handbook tells enrollees they “may be eligible to join ACCESS, a model that may lower your overall costs and give you access to convenient, technology-supported care.”
The reconciling detail sits in the same rules: some ACCESS organizations may waive standard Medicare cost-sharing for the patients they manage, though that waiver is optional and participation stays voluntary on every side. That optional waiver, not any change to Part A or Part B premiums or deductibles, is the specific mechanism through which the handbook’s hedged lower-costs language could become true for an individual enrollee, and CMS has not published how many of the more than 150 accepted organizations intend to offer it.
The program’s effect on total Medicare spending is similarly undetermined this early. CMS says the ACO benchmark work needed to see whether ACCESS payments are shrinking overall costs will not begin until 2028, and the model itself is only two months into a ten-year run built on projected outcomes rather than measured claims data. The lower-total-costs framing beneficiaries are reading in this year’s handbook describes an intended result CMS has committed to testing, not a savings figure any enrollee can bank on yet.
What is settled is the timeline and the entry point: a beneficiary reaches ACCESS through an existing primary care clinician’s referral, a participating organization’s payment now depends on documented results rather than documented visits, and whether that shift actually lowers what an enrollee owes will depend on choices, such as the cost-sharing waiver, that individual organizations have not yet had to report.
This article was produced with AI assistance and reviewed by The Money Overview editorial team.
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