Accountable Care Organizations & You:
FAQs for People with Medicare

FAQs For People with Medicare

Your doctors try hard to provide you with high quality care, but it can be a challenge to juggle information. Medicare wants to ensure that doctors have the resources and information they need to coordinate your care.

That’s why we’re partnering with many doctors, hospitals and other health care providers who are working together to provide better, more coordinated health care. They’ve decided to participate in an Accountable Care Organization (ACO).

If you have Original Medicare and your doctor, hospital or health care provider decides to coordinate with other health care providers through an ACO, you’ll benefit because the health care providers that care for you will be part of a coordinated team. They’ll work together to get you the right care at the right time in the right setting.

Resources

For general questions or additional information about Accountable Care Organizations for Medicare Beneficiaries, please visit the Medicare website or call 1-800-MEDICARE or 1-800-633-4227. TTY users should call 1-877-486-2048.

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If my doctor is in an ACO, can I still see whichever doctor I want?

Absolutely. If your doctor participates in an ACO, you can see any health care provider who accepts Medicare. Nobody—not your doctor or your hospital—can tell you who to see.

How do I know if my doctor is in an ACO?

If your doctor or health care provider chooses to participate in an ACO, there will be a sign posted in their office or in facilities such as hospitals and medical clinics. If you aren’t sure if your doctor or health care provider is participating in a Medicare ACO, ask him or her.

For general information on ACOs, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

What should I expect if my doctor is in an ACO?

Over time, if you see a doctor or health care provider participating in an ACO, you may notice that:

  • You don’t have to fill out as many medical forms that ask for the same information.
  • The health care providers that you see all know what’s going on with your health because they communicate with each other.
  • You don’t need to repeat medical tests because your results are shared among your health care team.
  • The providers participating in the ACO will work with you to make sure the care decisions reflect your preferences.

Your Medicare benefits won’t be limited because your doctor is part of an ACO. Also, you still have the right to choose any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t part of an ACO.

Some ACOs may hire people to help check on your care. They may call you after an appointment or a procedure to make sure you understand how to take your medicines or schedule follow-up visits. They may also share information with your doctor to make sure you get the right care.

Is an ACO a Health Maintenance Organization (HMO), managed care, or an insurance company?

No. An ACO is a group of doctors, hospitals, and other health care providers who work together to provide you with better, more coordinated care. Doctors and hospitals in an ACO communicate with you and with each other to make sure you get the care you need when you’re sick and the support you need to stay healthy and well.

An ACO isn’t an HMO, managed care, or insurance company. Unlike HMOs, managed care, or some insurance plans, an ACO can’t tell you which health care providers to see and can’t limit your Medicare benefits. If your doctor participates in a Medicare ACO, you always have the right to choose any doctor or hospital who accepts Medicare at any time.

Only people with Original Medicare can be assigned to an ACO. You can’t be assigned to an ACO if you have a Medicare Advantage Plan (like an HMO or a PPO).

What rights do I have if my doctor is in an ACO?

You’ll continue to have the same rights as all people with Medicare. To help you to get the best-coordinated and highest quality care, Medicare will share certain information about your medical care with your doctor’s ACO, including medical conditions, prescriptions, and visits to the doctor. This is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy and help you get the right care.

Your privacy is very important to us. You can tell Medicare not to give your doctor’s ACO information to coordinate your care by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Unless you take this step, your medical information will be shared automatically with your doctor’s ACO for purposes of care coordination and quality improvement.

If you’re now getting or received treatment in the past for alcohol or drug abuse, Medicare won’t share any information about that treatment with any ACO unless you give Medicare your written permission to do so.

Also, you may get a follow-up survey to ask about your experiences as a patient of a doctor who’s participating in a Medicare ACO. The ACO will use your feedback to help make sure you get high quality care.

Who can read my medical information, and will it be protected?

The group of doctors, hospitals, and other health care providers working together in the ACO will be able to read your medical records, along with other office staff authorized to help coordinate your care.

The privacy and security of your medical information is protected by federal law. Contact your doctor’s office for more information about how they protect your medical information, or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

How will an ACO lead to better care for me?

When your health care providers have access to your health information and are able to share that information with one another, they can give you better, more coordinated care. Each of your health care providers won’t only know about the health issues that they’ve treated, they’ll have a more complete picture of your health through communicating with your other health care providers.

When your health care providers participate in an ACO, you should see better, more coordinated care over time. With an ACO, you’re the center of care, and your satisfaction is one of their goals.

Where can I find more information about ACOs?

For more information about ACOs: