If you are enrolled or plan to enroll in traditional Medicare (not an Advantage Plan PPO) with a supplemental plan and separate drug plan you could be automatically enrolled in an ACO (Accountable Care Organizations). It may be beneficial for you to learn from your providers if they participate with an ACO group especially if you are seeing many doctors.
Read on to learn more.
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and/or other health care providers who work together to improve the quality and experience of care you get.
These organizations help your doctors and other health care providers understand your health history, and talk to one another about your care and your health care needs. This can save you time and money by avoiding repeated tests and unneeded appointments. It may make it easier to spot potential problems before they become more serious—like drug interactions that can happen if one provider isn’t aware of what another has prescribed.
ACO providers communicate with each other and partner with you in making health care decisions. They share information and may use
Electronic Health Records (EHRs)
, so you'll likely have fewer repeated medical tests and may save time on paperwork.
An ACO won’t limit your choice of health care providers. It isn’t a Medicare Advantage Plan, HMO plan, or an insurance plan of any kind. Only people with Original Medicare can be assigned to an ACO. If your doctor or other provider is part of an ACO, you still have the right to visit any doctor, hospital, or other provider that accepts Medicare at any time, and your Original Medicare benefits won't change.
If your primary care provider participates in an ACO, you may have access to additional tools or services that other people in Original Medicare don’t get. For example, in some ACOs, your provider can offer expanded telehealth services. This means you’d be able to get certain health care services no matter where you’re located, and from your home (instead of going to a health care facility) using technology, like your phone or a computer, to communicate in real time with your health care provider. Ask your provider if they offer these services.
You may also be able to get other benefits that aren’t available to people outside an ACO. For example, a doctor or other provider who is part of an ACO may be approved to send their patients for skilled nursing facility or rehabilitation care even if they haven’t stayed in a hospital for 3 days first, which is usually a requirement in Medicare. For you to qualify for this benefit, your doctor or other provider has to decide that you need skilled nursing facility care and meet certain other eligibility requirements.
If your primary care provider participates in an ACO and you have Original Medicare, you’ll get a written notice and you’ll see a poster in your provider’s office about their ACO participation. There are now hundreds of ACOs available across the country. Log into (or create) your secure Medicare account at Medicare.gov to select the primary care provider who will help you manage your health care in an ACO.
One of the most important benefits of an ACO is that your doctors and other providers can communicate and coordinate your care. To help with that, Medicare gives your health care provider’s ACO the opportunity to request certain information about your care. Securely sharing your data in this way helps make sure all the people involved in your care have access to your health information when and where they need it, to work together to get you the care you need.
If you don’t want Medicare to share your health care information this way, call 1-800-MEDICARE (1-800-633-4227) and tell that to the representative. TTY users can call 1-877-486-2048. If you decide you don’t want Medicare to give your health care information to your doctors or other providers, Medicare will continue to use your information for some purposes, like evaluating financial performance and quality of care.