Does an ACO change my Medicare coverage?

No. Attribution does not change Original Medicare, your premium, or your right to see any provider that accepts Medicare.

Is an ACO the same as a Medicare Advantage plan?

No. A Medicare Advantage plan has a network and an enrollment. An ACO in the Shared Savings Program is a payment arrangement for Original Medicare providers.

Can I refuse to be in an ACO?

You do not sign up for one. Medicare attributes you from the primary care you use. You can still see other Medicare doctors. Changing your primary doctor can change a later attribution.

Will the ACO lower my bills?

Not as a promise. Shared savings are between Medicare and the providers. Your deductibles and coinsurance still follow Original Medicare, or your plan if you have Medicare Advantage.

Medicare Accountable Care Organizations

What an ACO is

Medicare’s main version is the Medicare Shared Savings Program. The providers agree to coordinate care and to be measured. Medicare sets a spending benchmark for the patients attributed to that ACO. If spending comes in under the benchmark and the quality measures are met, the ACO may keep a share of the savings. In some models, if spending is over the benchmark, the ACO may have to pay Medicare back. The share is set by that model’s rules. It is not one national split.

You are not enrolled in it

If you have Original Medicare, Medicare may attribute you to an ACO because of the primary doctor you already see. You do not join it the way you join a plan. Your Medicare card, your Part B premium, and your right to see any doctor or hospital that accepts Medicare stay the same. You do not need a referral from the ACO. If an office says you must stay in a network or get a referral, that rule is coming from a Medicare Advantage plan or a medical group contract, not from this attribution.

It is not a medical group or an IPA

In Los Angeles County, people hear “medical group” and “IPA” at the front desk. Those names are about which doctors and hospitals work together on a plan contract. An ACO is a Medicare payment arrangement. A doctor can be in a medical group and also in an ACO. The two answers are different questions. Use the medical groups in a ZIP list only as names to ask about. It is not an ACO roster.

What it is trying to change

Original Medicare usually pays a provider for each covered service. An ACO adds a second score: the total cost and the quality of care for the group of patients. The hope is fewer repeated tests and more follow-up, because the providers share the record and the result. That is a hope, not a guarantee about your next visit. An ACO does not set your deductible, and it does not replace Part D.

How to ask

Ask the primary doctor’s office whether the practice is in an ACO, and what the name is. You can also call 1-800-MEDICARE (TTY 711). Attribution can change if you change the doctor you see most. If you have Medicare Advantage, your network and referral rules come from that plan. Read can I keep my doctor? for that check. An ACO notice, if you get one, is not an Annual Notice of Change and it is not a plan ID card.

Common questions

Does an ACO change my Medicare coverage?: No. Attribution does not change Original Medicare, your premium, or your right to see any provider that accepts Medicare.
Is an ACO the same as a Medicare Advantage plan?: No. A Medicare Advantage plan has a network and an enrollment. An ACO in the Shared Savings Program is a payment arrangement for Original Medicare providers.
Can I refuse to be in an ACO?: You do not sign up for one. Medicare attributes you from the primary care you use. You can still see other Medicare doctors. Changing your primary doctor can change a later attribution.
Will the ACO lower my bills?: Not as a promise. Shared savings are between Medicare and the providers. Your deductibles and coinsurance still follow Original Medicare, or your plan if you have Medicare Advantage.

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