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Costs & IRMAA

Some Original Medicare Patients May Owe Less at the Doctor Starting Next Spring

A new provision in Medicare's 2027 doctor payment rule lets accountable care organizations reduce or eliminate Part B cost-sharing for assigned patients starting April 1, 2027, subject to CMS approval.

By the Goodsurance editorial teamNovember 11, 2026

Medicare's calendar year 2027 physician fee schedule final rule, published in the Federal Register on November 9, contains a provision that gives accountable care organizations in the Medicare Shared Savings Program the ability to reduce or eliminate the out-of-pocket charges their assigned Original Medicare patients typically pay for most Part B services. The change takes effect April 1, 2027, for ACOs that apply and receive CMS approval.

Under standard Original Medicare rules, patients owe 20 percent coinsurance for most Part B services after meeting the annual deductible. The new policy allows approved ACOs to bring that share down or to zero for covered visits, lab tests, imaging, and other Part B services. Durable medical equipment, prosthetics, orthotics, supplies, and prescription drugs are excluded.

Starting April 2027, some Original Medicare patients may pay less at the doctor. Here is what a new ACO cost-sharing rule means for you.

ACOs that wish to offer this benefit must submit an implementation plan to CMS and receive formal approval. The agency plans to collect initial applications in early 2027, with the goal of approving eligible programs in time for participation starting in the second quarter. Not every ACO is expected to pursue the option.

CMS said the policy draws on experience from the ACO REACH model, a demonstration program that has tested similar cost-sharing flexibility in higher-risk populations. The same final rule also raised the shared savings rate for Level E of the BASIC track from 50 to 60 percent, giving ACOs a stronger financial incentive to manage costs.

Whether a given patient benefits depends on whether their doctors participate in an ACO that chooses to apply and wins approval. Many Original Medicare patients belong to practices affiliated with a Shared Savings ACO without necessarily being aware of it.

In plain words

Medicare has groups of doctors and hospitals that work together to coordinate patient care. These groups are called accountable care organizations, or ACOs.

Starting April 1, 2027, some of these groups can apply to Medicare for permission to lower what patients pay when they see the doctor or get a lab test. Right now, most Original Medicare patients pay 20 percent of the cost for visits, tests, and imaging after meeting a yearly deductible. Under the new rule, an approved ACO could cut that 20 percent charge or remove it entirely for people in its patient group.

This does not apply to medical equipment or prescription drugs. And not every ACO will choose to participate. Whether a patient sees any savings depends on whether their doctors are part of an ACO that applies for and receives CMS approval before mid-2027.

Many Original Medicare patients do not know if their doctors are part of an ACO. Patients can check Medicare's website or ask their doctor's office to find out.

Understand the basics first

Source: CMS
Read at the source →

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