FAQs For Beneficiaries

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

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 that 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).

If your doctor or health care provider chooses to participate in an ACO, you’ll be notified. This notification might be a letter, written information provided to you when you see your doctor, a sign posted in a hospital, or it might be a conversation with your doctor the next time you go to see him or her.

If you are not 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.

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 is going on with your health because they communicate with each other.
• You do not 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.

You will continue to get 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. 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 helping you get the right care.

Your privacy is very important to us. You can tell Medicare not to give your doctor’s ACO information that your doctor needs 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 are 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 is participating in a Medicare 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.

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.

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 will not only know about the health issues that they have treated, they will 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.

For more information about ACOs:

Visit www.CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/.

Visit www.medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.html.