Frequently Asked Questions (FAQs) about ACOs

How are ACOs different?

  • ACOs are NOT a health insurance plan
    • You still receive your health benefits from Original Medicare (or your commercial insurance plan)
    • You do not sign up for or join an ACO, though you can designate an ACO provider as your primary care provider (PCP) to be aligned to an ACO
    • Your providers will work together to share information about your care to avoid unnecessary repeated tests and to better coordinate your care
    • Being in an ACO does not limit the network of providers you may choose from

Who can get care from an ACO?

  • Anyone with Original Medicare (or another payer that contracts with an ACO) may receive care from an ACO provider
    • If your primary doctor is in an ACO, then you are automatically a part of the ACO, you don’t have to join or enroll
    • If you are in a Medicare Advantage plan, you cannot be in an ACO

How do I know if I am getting care from an ACO provider?

  • You can always ask your doctor or the staff if they are in an ACO
  • There may be a notice in the office about the ACO
  • You may get a letter from your doctor or from Medicare (or your respective insurer) letting you know the doctor is part of an ACO

What differences will I see if my doctor is in an ACO?

  • You may notice that your doctor may have a non-physician team member help you with coordinating your care, such as a care navigator, community health worker, or peer support specialist
  • You may receive calls from your doctor’s team asking about your health needs and helping you to arrange services, like transportation
  • Your doctor and their team may talk with you about your care plan and your treatment options
  • You may get reminders to get needed tests or to schedule appointments
  • You may notice that all your physicians are talking with each other, so you don’t have to fill out as many forms that repeat your information, and you should not have unnecessary duplicate tests or procedures

Do I still have a choice of providers?

  • Yes, you can still see any doctor or hospital that accepts Original Medicare (or your respective insurance plan). You do not have to choose ACO providers.

Can I opt out of the ACO?

  • Not without changing primary care providers. As long as you are receiving most of your care from a provider in the ACO you are considered to be in the ACO. If you choose a provider who is not in an ACO, and you get most of your care from that provider, then you won’t be in an ACO.

Can I opt out of having my health information shared with the ACO?

  • Yes. If you don’t want CMS to share your information with the ACO, you can ask to opt out of data sharing. Your doctors will continue to share information as a part of your care to make sure you get the best possible medical care.

More Information for Beneficiaries