Medicare 2026

Having Surgery at a TEAM Hospital: What Medicare's New Model Means for You

If you have Original Medicare and need one of a handful of common surgeries, you may notice a new label on your hospital or a letter in the mail about something called TEAM. It stands for the Transforming Episode Accountability Model, and it's a new way Medicare is paying selected hospitals for surgery and the recovery that follows. Here's what it is, what it isn't, and what it means for you as a patient.

What TEAM is

The Transforming Episode Accountability Model is a mandatory model from the Centers for Medicare & Medicaid Services (CMS) that runs for five performance years, from January 1, 2026, through December 31, 2030. CMS selected certain acute care hospitals in Core-Based Statistical Areas across the country to participate. If your hospital was selected, participation is required — the hospital cannot opt out, and neither can you when you receive covered services there.

TEAM applies to people with Original Medicare who have one of these five surgical procedures:

• Lower extremity joint replacement (such as hip or knee replacement)
• Surgical treatment of a hip or femur fracture
• Spinal fusion
• Coronary artery bypass graft (CABG)
• Major bowel procedures

An "episode" under TEAM starts with your inpatient hospital stay or outpatient procedure at a participating hospital and ends 30 days after you are discharged. During that whole window, the hospital is held accountable for both the cost and the quality of your care — including what happens after you go home.

What changes for the hospital — and what doesn't change for you

Under TEAM, Medicare may make additional payments to the hospital, or ask the hospital to pay money back, depending on how the episode goes. The idea is to encourage hospitals to coordinate care more carefully, reduce avoidable complications, and smooth your transition out of the hospital.

For you as a patient, CMS has been clear: the model is informational, and no action is required on your part. According to the patient notification letter CMS uses for TEAM:

• You keep all the same Medicare benefits, rights, and protections you had before.
• You cannot opt out of the model when you receive services from a TEAM hospital — but you remain free to seek care at a hospital that is not a TEAM participant if you prefer.
• Even though Medicare may make additional payments to the hospital, the amount you pay does not change because of TEAM.

One concrete change you may notice: TEAM hospitals are required to refer patients to primary care services. The goal is to make sure you have a regular doctor following up with you after surgery, which can help catch problems early and support your recovery.

What to do if something feels wrong

If you have questions or concerns about the care you receive — whether during your hospital stay or in the 30 days after discharge — you have the same options you've always had:

• Talk with your doctor or the hospital care team.
• Contact your Quality Improvement Organization (QIO), which handles quality-of-care complaints for people with Medicare.
• Call 1-800-MEDICARE (1-800-633-4227).

Medicare.gov has information about QIOs, your rights as a patient, and how to file a complaint or appeal.

A related change coming in 2028

TEAM isn't the only episode-based model in motion. In its FY 2027 inpatient hospital payment final rule, announced July 31, 2026, CMS said that beginning in January 2028, most hospitals will be required to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model. CJR-X covers hip, knee, and ankle replacements and holds the hospital accountable through the first 90 days of recovery after discharge. Certain hospitals, including TEAM participants, may be exempt. If you're planning a joint replacement in the next couple of years, it's worth asking your hospital which model, if any, applies.

How this fits with the rest of your Medicare picture

TEAM affects how Medicare pays certain hospitals; it does not change the structure of your coverage. You still choose each year how you want to get your Medicare benefits — through Original Medicare (often paired with a Medigap policy and a stand-alone Part D plan) or through a Medicare Advantage plan. Each path has trade-offs around provider choice, referrals, out-of-pocket costs, and extra benefits, and the right fit depends on your health, budget, and preferences. Medicare.gov has side-by-side information to help you weigh them.

A few program-wide numbers to keep in mind as you plan for 2027:

• The Part D out-of-pocket cap rises to $2,400 in 2027 (up from $2,100 in 2026).
• The most any Part D plan may charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33 (used in calculating the late-enrollment penalty; actual plan premiums are set plan by plan).
• Social Security announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.
• Annual Enrollment runs October 15 – December 7, 2026, with changes taking effect January 1, 2027.

The 2027 Part B standard premium and deductible, and the IRMAA income-related surcharges, had not been released as of this writing. CMS typically announces them in the fall; check Medicare.gov for the official numbers once they're posted.

If you have Medicaid or qualify for Extra Help with Part D costs, you have more flexibility to change coverage during the year. Since 2025, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. If you're a full-benefit dual-eligible, you can join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

What does this mean for people with Medicare?

If you're scheduled for one of the five covered surgeries at a hospital in the TEAM model, there's nothing you need to do differently. Your coverage, costs, and rights are the same. The hospital simply has stronger incentives to coordinate your care — including those first 30 days at home — and to connect you with primary care follow-up.

For official information, go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week.