The Centers for Medicare & Medicaid Services is adding four new disease-management tracks to a program that already reaches three out of four people on Medicare, with heart failure, chronic obstructive pulmonary disease, substance use disorders and tobacco cessation joining the lineup starting in spring 2027. The expansion arrives with a restriction the agency states plainly in its own announcement: the program serves only people enrolled in Original Medicare, and Medicare Advantage members are locked out, even though their private plans may run something comparable on their own. For a household deciding between Original Medicare and an Advantage plan during this fall’s enrollment window, that single eligibility line changes what each option actually includes for anyone managing a chronic condition.
What Launches in Spring 2027
The four additions are heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and tobacco cessation, according to the CMS press release announcing the expansion. The heart failure track is built around continuous monitoring aimed at measurable gains in function and symptom control. The COPD track targets lung function and day-to-day breathing capacity. The substance use disorder track covers opioid, alcohol and other addictions, including support for co-occurring depression and anxiety, and CMS ties it to the administration’s broader Great American Recovery initiative. A fifth change extends the existing musculoskeletal pain track beyond its original 12-month limit for certain conditions, so people already enrolled do not automatically lose support after a year. All of it runs under a program CMS calls ACCESS, short for Advancing Chronic Care with Effective, Scalable Solutions.
What the plan letter does not do: An Annual Notice of Change lists what changed, but never compares the plan against the alternatives on cost, drugs and doctors. Run the comparison in The 2027 Medicare Open Enrollment Decision Kit.
Original Medicare Only — Advantage Is Shut Out
CMS is not vague about who qualifies. The press release states it directly: “ACCESS supports people with Original Medicare; Medicare Advantage enrollees are not eligible, though their plans may offer similar programs.” That is not a proposal working through a comment period — it describes how the model already operates and how the new tracks will operate when they open in spring 2027. A person who switches from Original Medicare into an Advantage plan during this year’s enrollment period would be trading access to ACCESS for whatever chronic-care support, if any, their specific Advantage plan chooses to build on its own, since Advantage insurers are not required to replicate it.
How the Payment Model Actually Works
ACCESS is not a standard fee-for-service add-on. CMS Administrator Dr. Mehmet Oz said the model exists because too many people with chronic conditions were falling through the cracks between appointments, describing ACCESS as a tool meant “to bring healthcare into the digital age, giving patients and their providers greater access to AI-enabled technologies, remote monitoring, connected devices, and other innovative tools that can help identify problems earlier and improve care.” Rather than paying a participating organization for each individual service rendered, CMS ties payment to measurable improvements in a patient’s health, and participation is voluntary for both providers and patients — enrolling does not change a beneficiary’s underlying Medicare benefits, coverage or choice of doctor.
In practice, CMS says participating organizations can offer virtual care visits, health coaching, remote monitoring equipment and connected wearable devices between a person’s regular doctor appointments, with the goal of catching a worsening symptom before it turns into an emergency room visit or hospital stay. The model is built to plug into a person’s existing care team rather than replace it: a primary care doctor can refer a patient with Original Medicare into an ACCESS track, and the participating organization then works alongside that doctor rather than taking over the relationship. CMS also says 18 clinical and patient advocacy societies have expressed support for the broader effort to expand technology-supported chronic care access.
The Four Tracks Already Running
Before this expansion, ACCESS covered high blood pressure, diabetes, chronic musculoskeletal pain and depression. CMS says three out of four people with Medicare qualify for at least one ACCESS track once the new conditions are counted, which is why the eligibility line matters beyond a narrow slice of patients: heart disease, breathing problems, addiction and depression touch a large share of the Original Medicare population, not a niche group.
160 Organizations and a Directory Beneficiaries Can Check
CMS says 160 organizations will participate when the new tracks launch, with more expected to join over the model’s stated 10-year run. The agency is maintaining a public list at the ACCESS Model page on CMS.gov, where beneficiaries and their doctors can check which organizations near them participate and which conditions each one covers. Separately, CMS says major health payers covering 165 million Americans across Medicare Advantage, Medicaid and private insurance have pledged to adopt a similar outcomes-based payment structure, though a pledge from those payers is not the same as Medicare Advantage members gaining access to the federal ACCESS Model itself. Anyone with questions about eligibility can call 1-800-MEDICARE or check Medicare.gov/ACCESS directly, since the participating-organization directory is the only place CMS says the current list is kept current.
The Plan-Type Question ACCESS Just Made More Concrete
The ACCESS eligibility line turns on which type of Medicare a person carries, and that same distinction resurfaces every fall when Original Medicare and Medicare Advantage plans are weighed against each other. An Annual Notice of Change explains what changed about one specific plan for the coming year, but it does not put that plan next to Original Medicare or a competing Advantage option on cost, drug coverage or which doctors are in network.
The 2027 Medicare Open Enrollment Decision Kit is a 42-page decision kit built around a cost calculator spreadsheet, a prescription-by-plan comparison and a provider call script for checking whether a specific doctor is in network.
Compare coverage, medication costs and provider networks using The 2027 Medicare Open Enrollment Decision Kit.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources.
