What is an ACO?
An Accountable Care Organization (ACO) is a group of health care providers who have agreed to work together to give you high-quality, coordinated care. ACOs may take different approaches to giving you coordinated care. Some ACOs may have nurses that help you to set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your providers get equipment for you to monitor your medical conditions better at home if needed.

Do I have to participate in an ACO?
Only your provider participates in an Accountable Care Organization (ACO). You do not participate in the ACO. You still have the right to see any provider or hospital that accepts Medicare, at any time. You can continue getting care from your doctor, or you can choose to see a provider who doesn’t participate in an ACO.

Can I still see all of my regular Medicare providers even though one of them participates in an ACO?
Yes, it is important to know that:

• You can still go to any doctor, hospital, or other provider that accepts Medicare.
• Nobody can restrict which providers you see.
• Your coverage, premiums and insurance arrangements are not affected.
• You are still in Original Medicare and entitled to all the same Medicare services, benefits, and protections.

How will being in an ACO help my provider?
Providers in ACOs may have better access to the information, expertise, staff, and technology they need to make sure your care is coordinated across all the places you receive services. For you, this coordination could mean less paperwork to fill out at the provider’s office, avoiding duplicate or unnecessary tests, or more help to get access to additional services to manage your health conditions.

What information is Medicare sharing with the ACO?
The data that Medicare shares with the ACO is your contact information and billing information from Medicare claims data. The claims data involves all providers, hospitals, and clinics where you have been seen.

The data may show that you had an X-ray or lab test, but it will not show the results of those
tests. It will show the test name, date, and location where the test was performed.

If I decline to share my healthcare information, am I out of the ACO?
According to Medicare, “Even if you decline to share your healthcare information, Medicare will still use your information for some purposes, like assessing the financial and quality of care given by the providers participating in ACOs.”

This means that Medicare will not share specific information about you as a patient, but will
continue to share information about how the ACO is performing regarding financials and quality of care for all Medicare patients they see.