Accountable Care Organizations & You (PDF Document)

Accountable Care Organizations & You

Your doctors try hard to give you high quality care, but it can be a challenge to juggle information. Medicare wants to make sure your doctors have the resources and information they need to coordinate your care. Working together with Medicare, many doctors, hospitals, and other health care providers have decided to participate in Accountable Care Organizations (ACOs) to give better, more coordinated health care to patients like you.

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 they’ll work together to get you the right care, at the right time, in the right setting.

You can still choose any doctor

Your Medicare benefits won’t be limited because your doctor is part of an ACO. 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 a partof an ACO. Your doctor may make recommendations, but it’s always your choice on what doctors or hospitals you use.

An ACO is NOT a Health Maintenance Organization (HMO), managed care, or an insurance company

An ACO is a group of doctors, hospitals, and other health care providers who 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 get and stay healthy. Unlike HMOs, managed care, and some insurance plans, an ACO can’t tell you which health care providers to see or hospital to visit, and can’t limit your Medicare benefits. Also, 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 Preferred Provider Organization).

How to know if your doctor participates in an ACO

Doctors or health care providers who choose to participate in an ACO must display a poster that notifies you of your doctor’s participation in an ACO. It also informs you of your option to decline sharing your health care information by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you aren’t sure if your doctor or health care provider is participating in a Medicare ACO, ask him or her during your visit. For general information about ACOs, call 1-800-MEDICARE.

What to expect if your doctor is in an ACO

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 the goals. Over time, 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 their health care decisions reflect your preferences.

Know your rights if your doctor is in an ACO

You’ll continue to have the same rights all people with Medicare get. 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 unless you have called 1-800-MEDICARE to tell Medicare not to share your health care information with your doctor’s ACO or other ACOs. This information is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy.

Also, you may get a follow-up survey to ask about your experiences as a patient of a doctor who’s participating in an ACO. You’ll get a letter to let you know the survey is genuine. The ACO will use your feedback to help make sure you get high quality care.

ACOs are required to respect your privacy so you have the option to tell us not to share your health care information. You must call 1-800-MEDICARE (1-800-633-4227) to tell Medicare not to share information about your care with your doctor’s ACO or any other ACO. TTY users should call 1-877-486-2048. Unless you take this step, your medical information will be shared with your doctor’s ACO for purposes of care coordination and quality improvement.

Your medical information will be protected

Federal law protects the privacy and security of your medical information. The group of doctors, hospitals, and other health care providers in the ACO working together on your behalf will be able to read your medical records, along with other office staff authorized to help coordinate your 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 by sharing information with your other health care providers.

Contact your doctor’s office for more information about how they protect your medical information, or call 1-800-MEDICARE to learn more about how Medicare protects your medical information.

Where you can find more information about ACOs

For more information about ACOs:

Accountable Care Organizations ACO Phoenix, AZ