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Medicare ACO FAQ

What’s An Accountable Care Organization (ACO)?
ACOs are groups of doctors and other health care providers who voluntarily work together with Medicare to give you high quality service and care at the right time in the right setting.
  • Your doctor has agreed to participate in a Medicare Shared Savings Program ACO and to work closely with other doctors and health care providers in the ACO to coordinate care for Medicare beneficiaries, like yourself, who have traditional Medicare.
  • The ACO may share in any savings that result from providing you with high quality and more coordinated care.
Will the ACO change my Medicare benefits?
No. You’re still in Original Medicare, and your Medicare benefits, services, rights, and protections won’t change. You still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

Is an ACO an HMO or Medicare Advantage plan?
An ACO is not a Medicare Advantage plan or an HMO plan. 

Can I still see doctors/go to hospitals who are not part of this ACO?
You may continue to see doctors for your specific health needs as recommended by your primary care physician. It’s always your choice about which doctors you see or hospitals you visit.

Why did my doctor join this ACO?
Doctors and other healthcare providers choose to participate in an ACO because they’re committed to providing you with a better care experience. They may also be rewarded for offering you better, more coordinated, healthcare.

What is the goal of the ACO?
The goal of the ACO is to support your doctor in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

Will my Medicare benefits change?
No.

Will my relationship with my doctor change?
We hope your relationship with your doctor will improve. Medicare measures the ACO on patient satisfaction, so that you are a partner in making healthcare decisions.

Who will see my healthcare information?
The only people with access to your healthcare information are the specific providers caring for you. Personal information, like private conversations with your physician, will not be shared.

What information about me will the ACO have access to?
To help doctors who participate in an ACO give patients like you the best possible care, Medicare wants to share some additional information about your care with them. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward.

This information helps track the services you’ve already gotten, understand if you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. 
If you decide you do not want to have the information about your care shared with the ACO, you can do so.

How can I decline to have my personal health information shared?
We value your privacy, so it’s important to know that you can prevent Medicare from sharing this information at any time.

There are four ways that you can prevent your information from being shared:
  • You can call 1-800 MEDICARE (1-800-663-4227). TTY users should call 1-877-486-2048 and tell the operator you are calling about ACOs.
  • You can complete and sign the “Declining to Share Personal Health Information” form in your doctor’s office.
  • If applicable, you can complete and sign the “Declining to Share Personal Health Information” form and return it to GAPN at 5501 LBJ Freeway, Suite 950, Dallas, Texas 75240.
  • We can send you a form to sign and return it.

Also, Medicare will not share any information about alcohol and drug treatment history, if you have received such treatment, unless you choose in writing to share it.

After your form or phone call is received, Medicare will update its records to show that you do not want to have your data shared. If you call 1-800-Medicare, you will receive a letter confirming this change. It will take about 45 days for this change to take effect.

What if I change my mind and decide that I do want my personal health information shared in the future?
If you change your mind in the future, you may call our office and we will send you a form, called a “Consent to Change Personal health Information Preference” form that you can complete and mail back to 5501 LBJ Freeway, Suite 950, Dallas, Texas 75240.

Or you can call 1-800 Medicare (1-800-663-4227) and tell them that you have changed you mind and that you do want your data shared. You will receive a letter confirming this change.
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