Key Takeaways

  • Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care professionals that work together to give you better care.

  • ACOs are not insurance plans; you cannot join an ACO.

  • Getting care through an ACO does not change your rights to receive care from any provider or seek a second opinion.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care professionals that work together with the aim of giving you better care. They do this by coordinating their efforts and sharing information with one another, rather than working separately.

What are the goals of an Accountable Care Organization (ACO)?

  • Encourage your health care providers to work together so that you receive better care
  • Lower the costs of providing quality care

How do I know if I’m in an ACO?

When your provider joins an ACO, you will be notified. This notification may be a notice posted in the provider’s office, or an in-person communication from your provider. If you continue to see a provider who has joined an ACO for a majority of your health care needs, you may receive notification asking you to align with or be assigned to the provider’s ACO.

Do I have to join an ACO?

No. ACO alignment is voluntary. It is used mainly to calculate shared savings, which is a way for the provider to get more money from Medicare if they manage your care in a way that reduces your and Medicare’s costs. You can still see your provider, even if you do not want to voluntarily align with their ACO. Also, even after aligning or being assigned, you are still free to go to any provider, even those outside of the ACO. You are not required to receive care from your ACO. However, you can only be assigned to one ACO.

It is important to know that though ACOs are networks of health care professionals, they are not Medicare Advantage plans, health maintenance organizations (HMOs), or Medigaps. An ACO is not your insurance plan. Also, if you have a Medicare Advantage plan, you cannot join an ACO. You can still see providers who are part of an ACO if they are also part of your plan’s network, but the providers will not be able to count your care for the bonus payments or shared savings described below.

How is getting care at an ACO different from what I’m used to?

  • All of your providers (e.g., physicians, nurses, social workers) at an ACO work together. Your providers work together bysharing medical information and discussing treatment plans. They avoid duplicating care you’ve already received and aim to improve your health care experience. Providers also receive health care information about you from Medicare to help give you high-quality care.
    Example: You should not have to repeat the same tests or fill out the same forms multiple times.
  • ACOs involve you in the decision-making process. Providers at ACOs must take your unique needs, preferences, values, and priorities into account when developing care plans. However, know that each ACO is allowed to create its own program for patient engagement so the experience of patients with different ACOs might vary. Remember, you can only align with or be assigned to one ACO, but you can still get care from any Medicare provider.

What if I don’t want Medicare to share my information with an ACO?

You always have the right to request that Medicare not share your health and coverage information with an ACO. To do so, call 1-800-MEDICARE.

Also note that if you ever received or are receiving treatment for drug or alcohol use, Medicare will not share your information related to this care with an ACO unless you give them specific written consent.

What other rights do I have at an ACO?

Getting care at an ACO does not change your rights, including:

  • Freedom to choose your Medicare provider
  • Ability to seek a second opinion
  • Right to file a complaint
  • Right to appeal coverage denials

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