Medicare beneficiaries managing heart failure or a lung condition such as chronic obstructive pulmonary disease are getting a new coverage option, but only if they are enrolled in Original Medicare. The Centers for Medicare & Medicaid Services confirmed on September 15, 2026, that it will widen an existing chronic-care program to cover four additional conditions starting in the spring of 2027. The expansion reaches households already juggling multiple prescriptions and specialist visits, but it draws a firm line at the door of Medicare Advantage.
Four New Care Tracks Join the ACCESS Model in Spring 2027
The program at the center of the announcement is the Advancing Chronic Care with Effective, Scalable Solutions Model, known as ACCESS, which currently offers structured support for people with high blood pressure, diabetes, chronic musculoskeletal pain and depression. Starting next spring, CMS will add tracks for heart failure, chronic obstructive pulmonary disease, substance use disorders, and tobacco cessation, along with extended support for musculoskeletal pain that continues past the program’s initial 12-month period. The substance use disorder track is built to address opioid, alcohol and other dependencies together with co-occurring depression and anxiety, and CMS ties it to the administration’s separate Great American Recovery initiative.
Each track pairs remote monitoring and connected devices, such as wearables, with a care team that works alongside a beneficiary’s own doctor between regular appointments. CMS ties ACCESS payments to measurable improvements in a patient’s health rather than to the volume of services delivered, an outcomes-based structure the agency has used to recruit participating health systems and physician groups. The ACCESS Model webpage describes participation as entirely voluntary and states plainly that it does not change a beneficiary’s Medicare benefits, coverage, or choice of provider.
Free download: How to read the Annual Notice of Change, spot the cost, drug and network changes, and decide whether to keep or switch. Get the free 2027 plan-change checklist.
Why Original Medicare Is the Only Door Into ACCESS
The eligibility line is explicit in the CMS announcement itself: ACCESS supports people with Original Medicare, and Medicare Advantage enrollees are not eligible to join any of its tracks, including the four being added in 2027. CMS notes that Medicare Advantage plans may offer similar disease-management benefits on their own, but those arrangements are set individually by each insurer rather than through the federal ACCESS Model, so what is covered, and which services are included, can vary widely from one plan and county to the next.
That split matters because it separates two different kinds of Medicare decisions that can otherwise blur together in a mailbox full of plan notices: whether a beneficiary’s day-to-day chronic-care support comes through a federal model like ACCESS, and which annual Medicare plan a household is actually enrolled in each January. A person can qualify medically for a new ACCESS track and still be locked out simply because of the type of Medicare coverage they carry.
Three Out of Four Medicare Beneficiaries Already Qualify for a Track
CMS estimates that three out of four people with Medicare already meet the criteria for at least one ACCESS track under the conditions currently covered, a share that will grow once heart failure, COPD, substance use disorder and tobacco cessation are added next spring. The agency counted 160 organizations participating as the expansion was announced, with more expected to join over the model’s ten-year run. Patients and their doctors can check which local health systems and physician groups are already signed up, and which conditions each one covers, through the Medicare.gov directory CMS maintains for the program.
Eighteen clinical and patient advocacy societies have also expressed support for CMS’s approach, according to the agency, a signal that the model’s outcomes-based design has traction beyond the federal government itself. None of that support changes who can enroll; it affects how many organizations are available once an eligible beneficiary decides to ask a doctor about a referral.
What Enrolling Actually Changes Between Doctor Visits
Participating organizations can provide virtual check-ins, health coaching, remote monitoring and connected devices in the weeks between a beneficiary’s regular appointments, with primary care doctors able to refer patients directly into the model. For someone with heart failure, that could mean a connected scale or blood-pressure cuff feeding daily readings to a care team positioned to flag warning signs before they turn into an emergency room visit. For someone starting the new tobacco cessation or substance use disorder tracks, it means ongoing coordinated support rather than a single conversation at an annual physical.
CMS Administrator Dr. Mehmet Oz said the agency built ACCESS because too many people with chronic conditions were falling through the cracks between appointments, and framed the 2027 expansion as a way to reward providers for measurable results rather than for the sheer volume of care delivered. The model’s design does not require a beneficiary to change Medicare plans, switch doctors, or pay anything extra simply to be evaluated for a track.
What Medicare Advantage Enrollees Can Do Instead
Because ACCESS itself is closed to Medicare Advantage enrollees, CMS points those beneficiaries toward their own plan’s disease-management or care-coordination benefits, which are not standardized across insurers and need to be confirmed directly with the plan. Separately, major health payers covering roughly 165 million Americans across Medicare Advantage, Medicaid and private insurance have pledged to adopt an outcomes-based payment structure aligned with ACCESS, though that pledge does not open the federal model’s tracks to their own enrollees.
Beneficiaries with questions about eligibility, participating organizations, or the new 2027 tracks can call 1-800-MEDICARE or search the Medicare.gov directory CMS built for the program, the same official source that will be updated as the heart failure, COPD, substance use disorder and tobacco cessation tracks come online next spring.
What a New CMS Track Means for the Household Medicine Cabinet
The ACCESS expansion changes what kind of coordinated support exists between doctor visits, not which Medicare plan pays for prescriptions and specialist care in 2027. Original Medicare and Medicare Advantage households alike still face a separate task every fall: comparing next year’s premiums, drug formularies and provider networks during Open Enrollment. Most families make that comparison from a stack of mailed notices with no side-by-side worksheet in hand.
The 2027 Medicare Open Enrollment Decision Kit includes a prescription-by-plan comparison and a provider call script for households sorting through plan changes.
Read the prescription-by-plan comparison in The 2027 Medicare Open Enrollment Decision Kit.
AI-assisted research and drafting; reviewed by an editor.
