By Marc Gilman
Questions? Call (800) 927-9326 or email
Key Takeaways
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In 2021, CMS set a goal of having 100% of Traditional (Original) Medicare beneficiaries — and “the vast majority” of Medicaid beneficiaries — in accountable care relationships by 2030.
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This goal applies specifically to Original Medicare, not Medicare Advantage. It’s about whether your doctor participates in an Accountable Care Organization (ACO), not which insurance plan you’re enrolled in.
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CMS pursued this through three main initiatives: the Medicare Shared Savings Program, the ACO REACH Model, and the Kidney Care Choices Model — together covering more than 13 million beneficiaries by 2023.
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As of a May 2025 strategic pivot, the current CMS Innovation Center leadership has not reaffirmed the 100%-by-2030 target — a real, notable change from where this initiative stood just a couple of years ago.
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If you’re in Original Medicare, this affects you indirectly: it’s about whether your provider is financially accountable for your overall care quality and cost — not something you personally enroll in or opt out of.
What Was the Original Goal, and Why Does It Matter to You?
In 2021, the CMS Innovation Center set what it called a “bold goal”: get 100% of people with Traditional Medicare into an accountable care relationship with a provider by 2030, alongside “the vast majority” of Medicaid beneficiaries. Accountable care means a doctor, medical group, or hospital system takes on formal responsibility for a defined group of patients’ care quality and total cost — reducing fragmented care and unnecessary spending, at least in theory.
This is easy to confuse with Medicare Advantage or Medicare Supplement decisions, but it’s a genuinely different layer of the system. This goal was always about Original Medicare specifically — whether the doctors and hospitals treating you participate in a formal accountability structure, not which type of Medicare coverage you personally chose.
How CMS Planned to Get There
Three main vehicles carried this effort:
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The Medicare Shared Savings Program (MSSP) — the largest ACO program in the country. As of 2023, it included 456 ACOs covering 10.9 million assigned beneficiaries.
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The ACO REACH Model — aimed specifically at improving care coordination and expanding accountable care access in underserved areas, including enhanced benefits like at-home care. For 2023, it included 132 ACOs, over 131,000 participating providers, and about 2.1 million beneficiaries.
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The Kidney Care Choices Model — focused on coordinating care for beneficiaries with advanced chronic kidney disease and end-stage renal disease, aiming to delay dialysis onset and expand access to transplants. For 2023, it covered nearly 250,000 beneficiaries, an increase of 62% over the prior year.
Combined, these three initiatives involved more than 700,000 providers and organizations delivering care to over 13.2 million people with Medicare in 2023 alone.
What Changed in 2025
Here’s the part that’s easy to miss if you’re working from older reporting: in May 2025, CMS published a new strategic direction for the Innovation Center that notably did not reaffirm the 100%-by-2030 goal. The new leadership’s stated priorities shifted toward evidence-based prevention, consumer engagement, and technology-enabled care — emphasizing financial performance over the broad participation targets that defined the original push.
As of this writing, it remains genuinely unclear whether the 100%-by-2030 target is still active policy, has been quietly deprioritized, or will be replaced by a different formal goal. Some existing models tied to the original push — including ACO REACH — are set to conclude at the end of 2026, and stakeholders are still waiting for clarity on what, if anything, replaces them.
What This Actually Means If You Have Original Medicare
For most beneficiaries, this entire initiative operates in the background — you don’t sign up for an ACO the way you’d choose a Medigap plan, and your day-to-day experience of care may not change noticeably either way. But it’s still worth understanding, for a few reasons:
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It can affect referral patterns and care coordination — if your provider is part of an ACO, there may be more emphasis on coordinated follow-up, preventive care outreach, and communication between specialists.
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It doesn’t change your coverage or your costs directly — ACO participation is a provider-side arrangement, not a benefit or premium change for you.
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The uncertainty around this goal’s future is itself worth watching — if major models like ACO REACH wind down at the end of 2026 without a clear replacement, that could affect how coordinated your specific providers’ care delivery looks going forward.
What To Do Next
CMS’s original vision — 100% of Original Medicare beneficiaries in accountable care by 2030 — was a genuinely ambitious target, and the infrastructure built toward it (the Shared Savings Program, ACO REACH, Kidney Care Choices) reached real scale. Whether that specific 100% target survives under the current CMS Innovation Center direction is still an open question, and it’s one worth revisiting as more clarity emerges, particularly as 2026 model conclusions approach.
If you have questions about how your provider’s care coordination setup affects your coverage or experience, reach out and we’ll help you make sense of it.
Questions? Call (800) 927-9326 or email
