Medicare 2026

Medicare's LEAD Model Replaces ACO REACH in 2027: What Patients Should Know

As 2026 winds down, Medicare is retiring one accountable care program and starting another. ACO REACH ends on December 31, 2026, after four performance years (2023 through 2026). On January 1, 2027, a new 10-year model called the Long-term Enhanced ACO Design — LEAD — takes its place and runs through December 31, 2036. If you have Original Medicare, here is what the change means and what stays the same.

First, what is an ACO?

An accountable care organization is a group of doctors, hospitals and other providers who accept Original Medicare and agree to work together to coordinate your care. ACOs are not Medicare Advantage plans. Medicare.gov currently lists three ACO programs in Original Medicare: the Medicare Shared Savings Program, ACO REACH (ending December 31, 2026), and the new LEAD model (starting January 1, 2027).

Under any ACO, Medicare pays providers the same way it pays any other Original Medicare provider. Your costs do not go up because your doctor is in an ACO, and you keep the same coverage and rights — including the freedom to visit any Medicare provider, even one outside the ACO, and to switch providers at any time.

What's new about LEAD

LEAD is designed as the successor to ACO REACH, with a sharper focus on patients who need more support — including people who are dually eligible for Medicare and Medicaid and those who are homebound or home limited.

A few patient-friendly guardrails are built in. LEAD requires participating ACOs to tell aligned patients, in writing, that they keep all Original Medicare benefits and rights. LEAD also bars those ACOs from marketing Medicare managed care plans to patients aligned to them. In other words, your primary care office cannot use its ACO relationship as a sales channel for a Medicare Advantage plan.

LEAD also allows participating ACOs to offer optional incentives. The most notable is Part B cost-sharing support: participating providers may choose not to collect some or all cost sharing for certain Part B services from aligned patients. This support does not apply to durable medical equipment, prosthetics, orthotics or supplies, and people who already have supplemental insurance are not eligible for it. CMS has also said a Part D premium buy-down could become available by 2029.

As with any ACO, your primary care provider may offer extra benefits such as more telehealth, home care after a hospital stay, skilled nursing facility care without the usual 3-day inpatient stay (if you qualify), and help with certain copayments. Medicare.gov suggests asking your provider directly about what they offer.

How you end up "aligned" to a LEAD ACO

Most patients are aligned automatically, based on which participating practice provided the largest share of their primary care services. You can also choose to align yourself by naming a "primary clinician" on Medicare.gov, as long as you have both Part A and Part B, are not in a Medicare Advantage plan, PACE or a Medicare Cost Plan, have Medicare as your primary payer, and live in the ACO's service area.

If your primary care provider is in an ACO, you should receive a written notice or letter, and the office may post a sign. You can call 1-800-MEDICARE (1-800-633-4227) to confirm whether a provider participates. You can also call that number to opt out of Medicare sharing your personal information with ACO providers; Medicare may still share general information with the ACO to help measure quality.

Original Medicare vs. Medicare Advantage: a quick, neutral note

Because LEAD is only for people in Original Medicare, it is a good time to review your coverage. Original Medicare (often paired with a stand-alone Part D plan and, for some people, a Medigap policy) offers broad provider choice and the ACO protections above, but you may pay separate premiums for the different pieces. Medicare Advantage plans bundle coverage and may include extras, but typically use networks and prior authorization. Neither is "better" — it depends on your health, budget and preferences.

2027 numbers you can rely on

Several Part D figures are already set for 2027:

• Part D out-of-pocket cap: $2,400 (up from $2,100 in 2026).
• Maximum Part D deductible any plan may charge: $700.
• Part D base beneficiary premium (used in the late-enrollment penalty): $41.33. Actual plan premiums are set plan by plan.
• Annual Enrollment (Open Enrollment) for 2027 coverage: October 15 – December 7, 2026. Changes take effect January 1, 2027.
• Social Security announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, have not yet been released; CMS typically announces them in the fall. Watch Medicare.gov for the official numbers.

Special rules for people with Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move from Medicare Advantage to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. People who have full Medicaid benefits (full-benefit dual-eligibles) can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where to learn more

For official, up-to-date information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. These are the best places to confirm whether a provider participates in an ACO, understand your rights under LEAD, and check 2027 figures as CMS releases them.