What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other health care providers who agree to work together with Medicare to give you the best possible care.

An ACO is not a Medicare Advantage Plan or Health Maintenance Organization (HMO), and you do not enroll in an ACO. Your doctor and other health care providers may choose to participate in an ACO.

You still have Original Medicare (Medicare fee-for-service), and your Medicare benefits, services, rights, and protections haven’t changed. You still have the right to use any doctor or hospital that accepts Medicare at any time, the same as you do now.

How do ACOs coordinate patient care?

The goal of the ACO is to support your doctors in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, and more awareness of treatment options for various health conditions.

By working together, your doctors can do more to monitor your health and make sure you receive the highest quality care.

How do I know if a doctor participates in an ACO?

If a doctor is participating in an ACO, it’s the doctor’s responsibility to display a poster with information about ACOs and their participation in the patient area of their facility.

How does being in an ACO help my doctor?

Doctors and other health care providers choose to participate in an ACO because they’re committed to providing you with a better care experience. They may also be rewarded financially for offering you better, more coordinated care while keeping heath care costs low.

Doctors in ACOs may also 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.

Can I still see my other regular Medicare doctors and health care providers, even though my primary 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 still have Original Medicare (Medicare fee-for-service).
  • You still have all the same Medicare services, benefits, and protections.

What information about me will the ACO have access to?

Medicare shares additional information about your care with the ACO, including things like doctor, hospital, and pharmacy visits you’ve had in the past and have scheduled.

Your health care information helps the ACO track the services you’ve already received, understand where you may need more care, and find ways to smooth the transition for you if you have to transfer in or out of a hospital, or from the care of one doctor to another.

What if I don’t want to share my information with ACOs?

If you do not want Medicare to share your health care information with the ACO for the purpose of coordinating your care, you must call 1-800 MEDICARE (1-800-633-4227). Tell the representative that your doctor is part of an ACO and you don’t want Medicare to share your health care information. TTY users should call 1-877-486-2048.

After you 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 change your mind later, you can call back to reverse your decision.

Even if you decline to share your health care information, Medicare will still use your information for some purposes, including certain financial calculations and determining the quality of care given by your health care providers participating in ACOs.