An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care. ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully coordinate your care, and make sure your doctor has the most up-to-date information about your health.
The goal of the ACO is to support your doctor in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.
Doctors and other healthcare providers choose to participate in an ACO because they’re committed to providing you with a better care experience. They may also be financially rewarded for offering you better, more coordinated care. If your doctor chooses to participate in an ACO, you’ll see a poster with information displayed in the office or hospital.
An ACO isn’t a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.
How do I know if my doctor is participating in an ACO?
If your doctor is participating in an ACO, you’ll see a poster with information about your doctor’s participation displayed in the office or hospital.
If I haven’t been notified that my doctor is participating in an ACO, what do I need to do?
You don’t need to do anything right now. Even though your doctor is participating in an ACO, your Medicare benefits won’t change. You’ll still have Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time.
Do I have to participate in an ACO since my Doctor is?
Only your doctor, in this case my doctor, participates in an Accountable Care Organization (ACO). As the patient, you do not participate in the ACO.
You still have the right to see any doctor or hospital that accepts Medicare, at any time. You can continue getting care from your Doctor. Or, you can choose to see a doctor who doesn’t participate in an ACO.
Can I still see all of my regular Medicare doctors and healthcare providers even though my doctor participates in an ACO?
Yes, that doesn’t change. Always keep in mind that:
You can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see.
You’re still in Original Medicare.
You’re still entitled to all the same Medicare services, benefits, and protections.
Can I still choose to receive services from any new doctor, hospital or healthcare provider that I want to, even though my doctor is participating in an ACO?
Yes, you can still choose to go to any doctor, hospital, or other healthcare provider that accepts Medicare. Nobody – not even your doctor – can prevent you from seeing the doctors, hospitals or providers you want.
What information about me will the ACO have access to?
To help doctors who participate in an ACO give patients like you the best possible care, Medicare wants to share some additional information about your care with the ACO. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward. Your health care information helps the ACO track the services you’ve already gotten, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. If you do not want Medicare to share your health care information with the ACO, you can call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Tell the operator you’re calling about ACOs and you don’t want to share your health care information with an ACO.
How can I decline to have my health care information shared?
We value your privacy, so it’s important to know you can prevent Medicare from sharing this information at any time. Simply call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Tell the operator you’re calling about ACOs and you don’t want to share your health care information with an ACO.
After your talk with someone at 1-800 MEDICARE, Medicare will update its records to show that you don’t want to share your health care information. If you call 1-800 Medicare, you’ll get a letter confirming this change. It’ll take about 45 days for this change to take effect.
What if I change my mind and decide that I do want to share my health care information in the future?
If you change your mind in the future, call 1-800 Medicare (1-800-633-4227). Tell them you’ve changed you mind and that now you want to share your health care information with any ACO in which your doctor or other healthcare providers participates. You’ll get a letter confirming this change.
What if I’m already happy with my care the way it is?
We’re glad you’re having a positive experience already. Even though your doctor is participating in an ACO, you’ll continue to see him or her the way you have been. Your doctor’s participation in an ACO doesn’t change your benefits in any way, and decisions about your care stay with you and your doctor.
How will being in an ACO help my doctor?
Doctors in ACOs may have greater access to the expertise, staff, and technologies they need to make sure your care is coordinated across all the places you get services. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, or more help for you in dealing with any health conditions.