Medicare Beneficiaries

What is a Medicare Shared Savings ACO?

A Medicare Shared Savings Program Accountable Care Organization (ACO) is a group of doctors and other health care providers who agree to work together with Medicare to give better, more coordinated health care to individuals with Original Medicare, also known as Medicare fee-for-service or Medicare Parts A and B.

Can you still choose any doctor or hospital under an ACO?

Your Medicare benefits are will not change. A Medicare Shared Savings Program ACO is not a Medicare Advantage plan, an HMO plan, or an insurance plan of any kind. You still have the right to use any doctor or hospital that accepts Medicare, at any time. Your doctor may recommend that you see particular doctors or health care providers, but it’s always your choice about what doctors or providers you use and what hospitals you visit.

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

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 health 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 regular Medicare doctors and other healthcare providers, even though my primary doctor participates in a Medicare Shared Savings Program 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). And you still have all the same Medicare services, benefits and protections.

How do Medicare Shared Savings Program ACOs coordinate 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.

What information about me a Medicare Shared Savings Program ACO have access to?

Medicare shares information about your care with the ACO, including medical conditions, prescriptions, and visits to the doctor. 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.

If you choose to let Medicare share your health care information with an ACO it may also be shared with other ACOs in which your other doctors or health care providers participate. If you don’t want your health care information shared, you can ask Medicare not to share it. Having your health information gives us a more complete picture of your health.

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

Under Medicare Your Privacy is Very Important. Just like Medicare, ACOs must put important safeguards in place to make sure all your health care information is safe. ACOs respect your choice on the use of your health care information for care coordination and quality improvement.

If you want Medicare to share information about the health care you received with a Medicare Shared Savings Program ACO or with other ACOs that your other doctors or health care providers participate, there’s nothing more you need to do.

If you do not want Medicare to share your health care information, you need to do the following:

• • Call 1-800-MEDICARE (1-800-633-4227). Tell the representative that your doctor is part of an ACO and you do not want Medicare to share your health care information. TTY users should call 1-877-486-2048.
  • If you change your mind in the future, call 1-800-MEDICARE and tell the representative what you have decided. We can’t communicate with Medicare on your behalf.
  • Even if you decline to share your health care information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by health care providers participating in those ACOs.