Long-term care (LTC) encompasses the broad range of paid and unpaid medical and personal care services that assist with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping). The Department of Health and Human Services (HHS) reports that after age 65, over half of people will at some point need help with at least two activities of daily living, over half will use paid LTC, and over one-third will use some nursing home care. People under 65 with disabilities also rely on LTC for assistance with activities of daily living and instrumental activities of daily living. Medicaid is the primary payer for long-term care (LTC), and KFF analysis of Medicaid claims data found that over half of people who used any Medicaid LTC were under 65. 

Direct care workers play a pivotal role in providing LTC services. They perform demanding, high-stress work for low wages and often no benefits. This has contributed to the long-standing shortages and high turnover rates among direct care workers in both home care and institutional care settings. Recent federal policy changes could further exacerbate the challenge of retaining and growing the workforce to care for the aging population. Specific policy changes that could exacerbate these challenges include the following.

• Broad changes to Medicaid, including $911 billion in reductions to federal spending and Medicaid work requirements, could have implications for the direct care workforce given Medicaid’s outsized role in LTC spending and relatively high Medicaid coverage rates among direct care workers.
• Direct care workers may also feel the impacts of recent changes in immigration policy. Three in ten direct care workers are immigrants, including naturalized citizens and noncitizens, who include lawfully present and undocumented immigrants. The Trump Administration’s intensified immigration enforcement and restrictive policies are deepening anxiety and fear among immigrants of all statuses and could contribute to reduced immigration in the future, which could exacerbate workforce shortages.
• Two proposed rules from the Department of Labor may also have an impact on direct care workers. One rule would roll back minimum wage and overtime protections for home care workers. The other rule would make it easier for employers to classify direct care workers as independent contractors, which would strip them of some labor protections.
• CMS has also delayed enforcement of a provision in the Medicaid Access Final Rule that would have required states to establish an advisory group to provide recommendations on direct care worker provider rates.

This analysis uses the 2024 American Community Survey (ACS) to provide an overview of demographic and socioeconomic characteristics of the direct care workforce, including home health aides, personal care aides, and nursing assistants who work in nursing facilities, residential care facilities, home health, and settings that provide nonresidential services for older adults and younger adults with disabilities (see Methods). 2024 ACS data was released in late 2025 and is the most recent data available. Other KFF analyses on the direct care workforce in nursing homes include RNs and LPNs (collectively referred to as “nurses”), but this analysis excludes nurses and only includes aides that assist older adults and people with disabilities with essential daily tasks. Nurses provide key services for older adults and younger people with disabilities who use long-term care services but are excluded from this analysis because they are socioeconomically and demographically different than aides. Key takeaways include:

• In 2024, there were 2.3 million direct care workers who provided long-term care to people ages 65 and older and people under 65 with disabilities (Figure 1).
• Direct care workers are significantly more likely to be age 50 years or older, female, Black or Hispanic, or immigrants when compared to all other adult workers in the U.S. (Figure 2).
• Direct care workers are also significantly more likely to have a high school degree or less, work part-time, be low-wage, or be covered by Medicaid or be uninsured when compared to all other adult workers in the U.S. (Figure 2).
• The share of direct care workers who are immigrants varies by state, ranging from 0% in Wyoming to 60% in New York (Figure 4).
• At least one in five immigrant direct care workers is from a country within the 75 countries that are part of the Trump administration’s immigrant visa pause, which could further strain the workforce in future years (Figure 5).

In 2024, there were 2.3 million direct care workers who provided long-term care to people ages 65 and older and people under 65 with disabilities (Figure 1). Direct care workers include personal care aides, nursing assistants, and home health aides.Other sources use a similar definition of direct care workers but use data from the Bureau of Labor Statistics (BLS) to estimate the total number of workers, leading to different counts. The BLS data are more recent than the American Community Survey. See Box 1 for a definition of types of direct care workers included in this analysis.

Direct care workers provide long-term care services across a variety of settings, with 66% providing care in home care settings, 22% in nursing facilities, and 12% in residential care facilities (Figure 1). “Home care settings” include “home health” and “services for the elderly and people with disabilities” from Figure 1 and Box 1. Excluding Figure 1 and Box 1, this analysis presents these categories as one combined “home care” category. See Box 1 for definitions of the direct care worker and setting types. 

Direct care workers are significantly more likely to be age 50 years or older, female, Black or Hispanic, or immigrants when compared to all other adult workers in the U.S. (Figure 2). Direct care workers are more likely to be age 50 years or older when compared to all other adult workers (41% vs 33%), as well as more likely to be female (85% vs 47%). They are also more likely to be Black than all other adult workers in the U.S. (30% vs 11%). They are also more likely to be Hispanic when compared to all other adult workers in the U.S. (23% vs 19%).Immigrants, including naturalized citizens and noncitizens, make up 30% of the overall direct care workforce, higher than the share of all adult workers in the U.S. who are immigrants (18%).

Direct care workers are also significantly more likely to have a high school degree or less, work part-time, be low-wage, and be covered by Medicaid or be uninsured when compared to all other adult workers in the U.S. (Figure 2). Direct care workers are more likely to have a high school degree or less than compared to all other adult workers (55% vs. 31%). They are also more likely to work part-time and make less than $35,000 annually (referred to as “low wage”) when compared to all other adult workers (39% vs 18%; 66% vs 31%). Direct care workers are also much more likely to be covered by Medicaid (32%) than all other adult workers (9%) and more likely to be uninsured when compared to all other adult workers (13% vs. 9%).

Direct care workers in home care settings are different than direct care workers in nursing homes or residential care facilities (Appendix Table 1). A higher share of direct care workers in home care settings are immigrants (33%) when compared to direct care workers in nursing facilities (25%) and residential care facilities (23%) (Figure 3). Additionally, a higher share of direct care workers in home care settings work part-time (42%) when compared to workers in nursing homes (24%) and residential care facilities (25%). Similarly, a higher share of home care workers are low-wage (72%) when compared to those working in nursing homes (56%) or residential care facilities (58%) (Appendix Table 1).

Immigrants make up 30% of the overall direct care workforce providing long-term care services (Figure 3). Naturalized citizens make up a significantly larger share of direct care workers in home care settings (19%) when compared to nursing facilities (16%) and residential care settings (14%). Home care workers are also significantly more likely to be noncitizen immigrants (14%) when compared to workers in nursing homes (9%) and residential care facilities (9%). Noncitizen immigrants include both lawfully present and undocumented immigrants.

The share of direct care workers who are immigrants varies by state, ranging from 0% in Wyoming to 60% in New York, and, in many cases, reflects the share of overall immigrant workers (Figure 4). In 20 states, including many Southern states, the share of direct care workers who are immigrants is under 10%. In 9 states, the share of direct care workers who are immigrants is between 10% and 19%. In 9 states, 20% to 29% of direct care workers are immigrants, and in the remaining 13 states (including DC), 30% or more of direct care workers are immigrants. The share of direct care workers who are immigrants is strongly positively correlated with the overall share of workers in a state that are immigrants.

Immigrants from 13 countries make up nearly two-thirds (65%) of all immigrant direct care workers providing long-term care in the U.S. (Figure 5). The remaining one-third of immigrant direct care workers come primarily from a mix of countries in South and Central America, Africa, and Asia. Six countries each account for 5% or more of immigrant direct care workers: Mexico (14%), Dominican Republic (7%), Philippines (7%), Jamaica (6%), China (6%), and Haiti (6%).

At least one in five immigrant direct care workers is from a country that is part of the Trump administration’s immigrant visa pause (Figure 5). Among the top 13 countries that make up nearly two-thirds of immigrant direct care workers, five of them are part of the Trump administration’s immigrant visa pause (Jamaica, Haiti, Nigeria, Cuba, and Ghana) that impacts 75 countries. While the immigrant visa pause is facing a court challenge, it currently remains in effect. On June 25, 2026, the Supreme Court issued a ruling allowing the Trump administration to proceed with terminating Haiti’s TPS designation, which could impact over 300,000 Haitian TPS holders. These policies could further strain the workforce in future years.

Methods

Data: These findings are based on KFF analysis of the 2024 American Community Survey (ACS) 1-year Public Use Microdata Sample (PUMS) files. The ACS includes a 1% sample of the U.S. population, and the subset of direct care workers used here includes 19,612 observations.

Identifying Direct Care Workers in ACS: Direct care workers are those who fall into the following occupation codes: Home health aides (3601); Personal care aides (3602); and Nursing assistants (3603). This analysis only includes those who work in the following industries: Home Health Care (8170), Nursing Care Facilities (8270), Residential Care Facilities (8290), and Individual and Family Services (8370). “Individual and family services” are also referred to as “services for the elderly and people with disabilities.” Home health care and individual and family services are collapsed into “Home care” for this analysis. These industries capture most workers providing long-term health services. The ACS only includes the primary industry and occupation of a respondent’s current or most recent (in case the respondent is not currently working) job.

We define the direct care workforce as all individuals 18 and older who earned at least $1,000 during the year and indicated that their job was in both the long-term care industry and occupation codes listed above. The comparison group “All Adult Workers in the U.S.” includes all individuals 18 and older who earned at least $1000 during the year.

Health Insurance Coverage in ACS: The ACS asks respondents about their health insurance coverage at the time of the survey. Respondents may report having more than one type of coverage; however, individuals are sorted into only one category of insurance coverage. See notes here for more information on the insurance coverage hierarchy.

Identifying Immigrants in ACS: Immigrants are identified as those who report their citizenship status (variable name: CIT) in ACS as being a “U.S. citizen by naturalization” or as “not a citizen of the U.S.”, with the former being grouped under “naturalized citizens” and the latter being grouped under “noncitizen immigrants” for the purpose of this analysis. Noncitizen immigrants include lawfully present and undocumented immigrants.

Appendix

Characteristics of Direct Care Workers and All Other Adult Workers

*Indicates statistically significant difference between Direct Care Workers and All Other Adult Workers at the p<0.05 level. NH=Non-Hispanic.

KFF analysis of American Community Survey, 2024

The contraceptive implant is the most effective reversible birth control method available. Implants, along with intrauterine devices (IUDs), are known as long-acting reversible contraception (LARCs) because they can be used to prevent pregnancy for several years and can be removed at any time. Implants have been available since the 1990s and have undergone substantial design modifications since their debut. The newest generation implant was introduced to the U.S. market in 2006 and remains the only contraceptive implant available in the U.S. Barriers to implant use include limited awareness and availability, high up-front costs for clinicians to stock the device, and required insertion and removal by a trained clinician. This fact sheet provides an overview of contraceptive implants including use, availability, and financing.

Background

In 1990, the Food and Drug Administration (FDA) approved Norplant, manufactured by Leiras Oy, the first subdermal contraceptive implant that was inserted under the skin of the upper arm by a trained clinician. Made of silicone, it had six capsules containing levonorgestrel, a synthetic hormone, and was effective for up to five years. Following concerns about its effectiveness and lawsuits on behalf of users who experienced complications, Norplant’s distributor, Wyeth-Ayerst, discontinued its U.S. distribution in 2002.

In 2006, the FDA approved Implanon, a single, thin, plastic, etonogestrel-releasing rod inserted under the skin of the arm. It is manufactured by Organon USA, a division of Merck. The improved design and composition made Implanon easier and faster to insert and remove than first generation implants. In 2010, the manufacturer replaced Implanon with Nexplanon, which is designed to be radiopaque (visible through x-ray) and has an improved insertion device. It is FDA-approved for use up to five years and prevents pregnancy by suppressing ovulation.

With a 0.05% failure rate, the contraceptive implant is the most effective FDA-approved reversible contraceptive. Additionally, the implant removes the potential for user error and non-use associated with self-administered contraception because it is inserted by a clinician and does not require any regular maintenance by the user.

Implants must be inserted and removed by a trained clinician who uses a special insertion device to place the implant just under the skin of the patient’s upper arm. Once inserted, the clinician ensures proper placement of the device by palpating the insertion site. The minor surgical procedure takes a few minutes and requires a local anesthetic and a small incision. After five years of use, the implant must be removed by a trained clinician, and if the patient desires, a new implant can be placed at that time. Implants may be removed by a clinician at any time before five years, and pregnancy can occur as soon as the first week following removal. 

Contraceptive implants are safe for most people and can be inserted any time if the user is not pregnant. Implants are primarily used for pregnancy prevention, but they can also be used to reduce menstrual cramps and make menstrual periods lighter. While there has been some concern about hormonal contraception for individuals who are breastfeeding, findings from the U.S. Selected Practice Recommendations for Contraceptive Use show that progestin-only methods, such as the implant, do not appear to negatively affect breastfeeding outcomes. Some common side effects include irregular menstrual bleeding, headache, weight gain, and breast pain, which may lead to discontinuation among some users. Although rare, some users who smoke or have certain health conditions may have a higher risk of developing severe complications.

Implant Use, Availability, and Awareness

Use

Because of their efficacy, continuation, and satisfaction rates, leading medical groups including the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics have recommended the use of implants for most individuals of reproductive age, including adolescents and nulliparous and postpartum women. However, research demonstrates persistent misperceptions and a lack of awareness about implants. Although implant use in the U.S. has increased since it was first introduced in 1995, it is still lower than other contraceptive methods such as the IUD, pill, and sterilization.

Between 2022 and 2023, the most recent years for which there are national data, 5% of women ages 15-49 who were currently using contraception used the implant (Figure 1). Implant users tended to be younger, lower-income, and covered by Medicaid. Notably, one in ten (11%) adolescent girls who use contraception report using the contraceptive implant compared to only 1% of women ages 35 to 49. Possible explanations for the association of higher implant use among younger women and lower-income women include the desire to avoid pregnancy for a longer period of time, lower maintenance and chance of user error, promotion of LARCs by medical organizations for adolescents, and availability at publicly funded clinics.

Availability and Awareness

Access to implants can depend, in part, on the clinician’s ability and willingness to offer them. A 2023 KFF survey of OBGYNs found that eight in ten (83%) OBGYNs provided contraceptive implants in their practice. Publicly funded family planning clinics are an important source of care for many low-income and uninsured people of reproductive age. Access to contraceptive implants has been challenging for some clinics due to high upfront costs, as well as limited training and staff capacity to insert the device. As a result, some sites may be unable to provide the full range of contraceptive services to their patients, including contraceptive implants. Overall, 75% clinics offered implants from 2022-2023 compared to 61% in 2015.

Physicians may require multiple visits for a contraceptive implant insertion, which can be inconvenient for patients with limited time and resources. ACOG recommends OBGYNs implement same-day insertion procedures to improve patient access and experiences with contraceptive care, but some clinicians report barriers such as high upfront costs and challenges with reimbursement for contraceptive implants. Nonetheless, the share of publicly funded family planning clinics that offer same-day contraceptive implant insertions has increased overall. Between 2022 and 2023, about two-thirds (69%) of clinics performed same-day insertions, compared to one in three (37%) in 2015. 

In 2026, the FDA made some changes to the provision of implants. One change was the extension of the use of the implant from three to five years. Additionally, the FDA made the implant available only through the FDA’s Risk Evaluation and Mitigation Strategy program (REMS), a drug safety program with special requirements for clinicians, pharmacies, and other distributors who wish to provide the implant, due to the rare but serious health risks associated with improper insertion of the device. The Nexplanon REMS program requires clinicians to register with REMS, pass a specialized knowledge assessment, and complete an in-person 90-minute training from the manufacturer to become certified in Nexplanon insertion and removal. In addition to medical doctors, the training is open to advanced practice clinicians (such as nurses and physician assistants) who are authorized to perform implant insertions and removals in their practice jurisdiction. Additional clinical training for the implant is available from a variety of reproductive health organizations.

Insurance Coverage and Financing of Implants

The wholesale price for an implant is about $1275, in addition to potential costs associated with insertion and removal. The Affordable Care Act’s (ACA) contraceptive coverage requirement eliminated many women’s out-of-pocket costs for contraceptives, although some women still do not have access to full coverage.

There is currently no generic or therapeutically equivalent version of Nexplanon available in the U.S. Nexplanon’s manufacturer, Organon USA (a division of Merck), currently holds patents on the device and associated materials, though these patents are set to expire between 2027 and 2030.

Private Insurance

The ACA includes a requirement that most private insurance plans cover at least one type of all 18 FDA-approved contraceptive methods as prescribed without cost sharing. This means that most private plans must cover the implant at no cost to policy holders. Before the ACA was passed, individuals with private insurance were likely to face out-of-pocket expenses for the implant and associated visits. After the contraceptive coverage mandate went into effect in 2012, research found that about three in four (73%) women with private insurance paid $0 in out-of-pocket expenses for contraceptive implants in 2020, compared to about three in then (28%) in 2012. However, recent research suggests an increase in the number of women with out-of-pocket expenses for contraceptive implant insertion, despite the coverage requirement. While nearly two-thirds (64%) of women with private insurance continued to have no out-of-pocket expenses for contraceptive implant insertion, over one in three (36%) paid a median cost of $16.88 for implant-related services in 2023—including office visits, ultrasounds, medications, and STI and pregnancy testing. Nonetheless, studies have found an increase in LARC initiation overall among women with private insurance coverage since the ACA’s coverage requirement took effect.

Insurers can use medical management to help control costs and encourage beneficiaries to choose more affordable contraceptive methods, but federal guidance prohibits insurers from categorically restricting access to a particular contraceptive method. Insurers can choose to cover generic contraceptives while charging cost-sharing for the brand-name version. Since contraceptive implants do not have a generic equivalent, the brand-name version (Nexplanon) must be covered without cost-sharing.

Medicaid

Federal law requires Medicaid programs to cover family planning services and supplies without cost sharing, but there are variations in coverage between states and between different Medicaid populations. For enrollees of the traditional Medicaid programs that were in place prior to the passage of the ACA, coverage of implants is determined by each state program. Recognizing the high (cost) effectiveness of LARCs, many states are pursuing policies to reduce barriers to provision, like reimbursing for insertion and removal, returning unused devices for credit, and providing hospitals with separate payments for post-partum LARC insertion.

Those who qualify for Medicaid under the ACA’s expansion of the program must receive coverage for the implant because the ACA requires these expansion programs to cover all FDA-approved methods for women without cost sharing, which is the same as the requirement for private insurance plans. Furthermore, 30 states and D.C. extend Medicaid coverage for family planning services, including contraception, to some uninsured women who do not qualify for full scope Medicaid.

Uninsured

The federal Title X Family Planning Program funds a network of clinics to provide family planning care to millions of low-income and uninsured people at reduced or no cost. Federal guidelines such as the Office of Population Affairs’ and the CDC’s Providing Quality Family Planning Services (QFP) and the Health Resources and Services Administration’s (HRSA) recommendations for women's preventive services state that offering women the full range of FDA-approved contraceptive methods is a crucial aspect of quality family planning services.

Research shows that sites that received Title X funds were consistently more likely to offer contraceptive implants compared to sites that do not receive Title X funding. Community health centers (CHCs) and specialized family planning clinics such as Planned Parenthood centers play a critical role in providing reproductive health care to low-income people, medically underserved communities, and people who are uninsured. CHCs are required to provide “voluntary family planning” services but have significant leeway in determining the specific services they provide. For example, nearly all (98%) Planned Parenthood clinics offered same-day implant insertions from 2022 to 2023, compared to just over half (57%) of federally qualified health clinics.

As a result of the 2025 One Big Beautiful Bill Act and other federal policy changes, the uninsured rate is expected to rise substantially over the next decade. Uninsured women could decide to stop using contraception because they cannot afford it or switch to a less effective method, which could result in an increase of unwanted pregnancies and a loss of reproductive autonomy. KFF research has found that one in five uninsured women of reproductive age has had to stop using a birth control method in the past 12 months because they couldn’t afford it, a rate that is four times greater than those with Medicaid (5%) or private insurance (2%).

As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. Broadly speaking, these technologies include health-related applications (“apps”), online patient portals, and connected devices such as smartphones and wearable devices that can be used to measure or track health data.   

A central component of CMS’s efforts in this area is the Health Tech Ecosystem, launched in 2025, through which CMS partners with private-sector organizations, including health care providers, payers, health app developers, and electronic health record vendors, to increase the availability of digital health tools and improve access to and exchange of electronic health information. While the initiative spans all CMS programs, people with Medicare gained access to the first wave of personalized health apps through the new Medicare app Library launched in April 2026, which allows beneficiaries to access third-party apps that have undergone independent review and meet certain requirements for privacy and security.

Separately, CMS introduced the ACCESS Model, a new Center for Medicare and Medicaid Innovation payment model scheduled to begin in July 2026 that aims to expand access to technology-enabled care for people in traditional Medicare with certain chronic conditions. CMS also enhanced the Medicare Plan Finder, the official online tool on Medicare.gov that helps beneficiaries compare and select Medicare coverage options.

This brief summarizes these digital health initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts about recent experiences with and use of digital health tools among Medicare beneficiaries and older adults more generally.

The CMS Health Tech Ecosystem Aims to Expand Access to Patient-Facing Apps and Improve Health Data Exchange  

As part of the CMS Health Tech Ecosystem, dozens of companies have pledged to develop patient-facing apps that support exchange of health data and enable connectivity to the new Medicare App library, where people with Medicare can access third-party apps that meet CMS’s privacy and security criteria. To support the use of these tools, participating app developers, health information networks, electronic health record vendors, and payers have agreed to adopt common standards that make it easier for patients and providers to access and exchange electronic health information through the apps. The Medicare App library that launched in April 2026 will feature apps that meet one of the following initial use cases:

• Supporting management and prevention of diabetes and obesity, such as features that enable medication management or include resources related to prediabetes.
• Integrating conversational artificial intelligence (AI) assistants to help people navigate their care options and manage aspects of their health care, such as checking symptoms.
• Allowing patients to securely share their health and identity information electronically at check-in instead of completing paper forms (so-called “kill the clipboard” apps). Patients can also receive a summary of their visit through the same platform.

As of June 2026, the Medicare app library lists five apps that are available to beneficiaries and an additional eight apps that are expected to be added soon. A search tool on the app library website enables a comparison of apps based on 13 key features, such as managing health records, connecting to wearable devices, or sharing information with caregivers or providers, as well as searching for apps tailored to a range of health conditions and by price, with some apps being free and others requiring a subscription or having paid features.

CMS’s efforts to expand the availability of health care apps that have been vetted by the agency and meet specified standards for privacy and security build on the popularity and appeal of these tools, including among older adults.In 2025, eight in 10 (78%) Medicare beneficiaries ages 65 and older used a health care app or website to manage their health care in the past year, and more than half (58%) said these tools make managing their health care easier, according to a September 2025 KFF Health Tracking Poll (Figure 1). Three-quarters (75%) say they have used a health care app or website to access their medical records or lab results, the most common reported use of health apps among Medicare beneficiaries.

In addition, nearly two-thirds (63%) of older adults on Medicare say it’s important for Medicare to increase the availability of apps that help manage chronic conditions with the help of a health care provider, but few older adults on Medicare—about one in four (23%)— say they have used a health app or website in the past year to manage a chronic condition with their health care provider.

The ACCESS Model Expands Access to Technology-Enabled Care for People in Traditional Medicare with Certain Chronic Conditions

The CMS Innovation Center launched the ACCESS Model in December 2025 to test a national, voluntary payment approach that uses technology-supported care options to help traditional Medicare beneficiaries prevent and manage a specified set of chronic conditions. These chronic conditions are grouped into an initial set of four clinical tracks, two of which target cardiovascular, kidney, or metabolic conditions (e.g., hypertension, diabetes), one that targets musculoskeletal conditions (e.g., chronic musculoskeletal pain), and another that targets behavioral health conditions (e.g., depression). About 7 in 10 Medicare beneficiaries have conditions that qualify for at least one track, though this estimate may change as CMS considers additional conditions and clinical tracks in the future.

The model is voluntary for both participating organizations and people in traditional Medicare, who need to enroll directly with participating organizations or through a referral from their provider. It will run for 10 years from July 2026 through June 2036, with organizations joining in cohorts on a rolling basis throughout the model period. Medicare beneficiaries may disenroll or switch participating organizations after 90 days of their enrollment, and participating organizations may withdraw with advance notice to CMS and beneficiaries. 

To date, 190 organizations have been accepted as participants, including digital health companies, mental health organizations, health systems, and physician groups, most of which, according to CMS, have not previously served Medicare beneficiaries. These participants, who must enroll as Medicare Part B providers or suppliers, will receive monthly payments for managing beneficiaries’ qualifying conditions, with full payment tied to achieving certain health outcomes, such as helping a beneficiary with hypertension lower their blood pressure to a specific level. Currently, the vast majority of accepted applicants (151 organizations) have signed up for at least one of the two tracks focused on cardiovascular, kidney, or metabolic conditions, while 108 have signed up for the track on behavioral health conditions and 76 for the musculoskeletal track. Because organizations can participate in multiple tracks, these categories are not mutually exclusive.

Currently, it is unclear how broadly individual participants will operate geographically or the scope of services offered by each participant. CMS plans to launch a public directory of all ACCESS participants in July 2026, allowing people with Medicare and their providers to identify participating organizations, the conditions they treat, with risk-adjusted outcome measures for each organization expected to be added beginning in 2028. Organizations that participate in the model and also pledge to join the Health Tech Ecosystem will also be featured in the Medicare App Library as participants.

Participating organizations may use a variety of digital tools to deliver services under the Model, ranging from FDA-regulated medical devices such as continuous glucose monitors, to mobile applications, wearables, and non-FDA regulated software. CMS gives participants flexibility in selecting technologies and clinical tools that support the model. Some tools may be classified as clinical devices, including continuous glucose monitors, blood pressure cuffs, and wearable devices such as fitness trackers and smartwatches. Beneficiaries may receive these tools on either a loan or ownership basis from the participating organization or use their own devices. While participants generally may not require beneficiaries to purchase or rent devices classified as clinical, beneficiaries may still need access to non-clinical technologies, such as internet access, tablets, or smartphones to use technology-enabled services.

Variation in the technologies used under the ACCESS Model, as well as Medicare beneficiaries’ access to and familiarity with digital tools, may lead to differences in how people in traditional Medicare access and experience technology-supported care under this model. For example, some beneficiaries may enroll with participating organizations that incorporate the use of technologies already integrated into their care, such as Medicare-covered continuous glucose monitors. Others may enroll with participating organizations that incorporate technologies such as wearable fitness trackers that are generally not covered by Medicare and may be less widely adopted among beneficiaries. For example, in 2024, just under a quarter (23%) of adults ages 65 and older used an electronic wearable device to monitor or track their health or activity in the past year, based on KFF analysis of the Health Information National Trends Survey (Figure 1).  However, among older adults who use wearable devices, the vast majority (85%) said they would be willing to share data from their device with their health care providers.

Medicare Advantage enrollees, who account for more than half of all Medicare beneficiaries, do not qualify for the ACCESS Model, but 16 insurers, including those serving Medicare Advantage enrollees, have pledged to adopt similar models of care to date. Many Medicare Advantage enrollees report having conditions being targeted by the ACCESS Model, including hypertension (64%), diabetes (35%), and depression (28%), based on a KFF analysis of the 2023 Medicare Current Beneficiary Survey (MCBS). Because details about the programs pledged by the 16 insurers are not yet available, it is unclear how they will be structured or the patient populations that will be targeted, though they may resemble existing supplemental benefits offered by Medicare Advantage plans. In 2026, 44% of enrollees are in individual Medicare Advantage plans that offer remote access technologies, which may include clinical devices such as continuous glucose monitors, and 95% are in plans that offer fitness benefits, which may include discounts on wearable devices. For example, some plans offered by Devoted Health, which has pledged to align with ACCESS, offer partial reimbursement for the purchase of a wearable device as part of a fitness benefit. While CMS collects data on use and spending on supplemental benefits in Medicare Advantage plans, such as the number and characteristics of enrollees who use these benefits, this data is currently unavailable to researchers and consumers.

Changes to the Medicare Plan Finder Could Make It Easier to Compare and Select Medicare Coverage Options

In 2025, CMS announced enhancements to the Medicare Plan Finder, the official tool on the Medicare.gov website that helps beneficiaries compare and select Medicare coverage options. These enhancements include the following updates: 

• Offering Medicare Advantage provider directory information to help beneficiaries identify whether their doctors are in a plan’s network. Unlike traditional Medicare, most Medicare Advantage insurers use provider networks, which can change from year to year. Medicare beneficiaries say having access to their preferred providers is an important factor when selecting their Medicare coverage, yet in 2022, Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area. Prior to 2025, the Medicare Plan Finder did not include data on provider networks, resulting in beneficiaries’ going to each plan’s website or third-party sources to determine whether their preferred providers were in the network. Incorporating provider directory information in the Medicare Plan Finder may make it easier for beneficiaries to evaluate their coverage options, though the usability and completeness of this feature continue to evolve.
• Showing additional details on more than 30 supplemental benefits under Medicare Advantage. These details include in-network and out-of-network cost sharing amounts, whether prior authorization is required for each benefit, and whether there are limits on how much the plan will provide. Currently, most Medicare Advantage enrollees are in plans that offer supplemental benefits not covered by traditional Medicare, such as vision, hearing, and dental, and beneficiaries highlight the availability of extra benefits as a reason they choose to enroll in Medicare Advantage plans.

CMA also announced the launch of an “AI-powered” prescription drug search tool that will provide personalized cost comparisons across pharmacies. While prescription drug costs covered under Medicare Part D, including premiums and deductibles, can change from year to year and vary by plan, most enrollees in Medicare Advantage prescription drug plans (81%) and stand-alone prescription drug plans (69%) in 2023 did not compare their plans’ drug coverage with drug coverage offered by other plans in their area. According to CMS, the new prescription drug search tool will be available on Medicare.gov to users with an individual account but will not be incorporated in the Medicare Plan Finder. This tool could provide more individualized guidance to help Medicare beneficiaries lower their prescription drug costs beyond the prescription drug lookup tool that is already incorporated in the plan finder.

However, these enhancements will require beneficiaries to access the Medicare website and navigate the plan finder, even as just over half (53%) of Medicare beneficiaries said they hadn’t visited the Medicare website, according to KFF analysis of the 2023 MCBS, and it is unknown how many beneficiaries have used the Medicare Plan Finder specifically to compare coverage options or enroll in a plan. But with less than a third (28%) of Medicare beneficiaries comparing their coverage options during a previous open enrollment period for Medicare, enhancements to Medicare Plan Finder and Medicare.gov may help address some of the challenges beneficiaries face when evaluating their coverage options and comparing costs.