Medicare’s Accountable Care Organizations

medicare

submitted by: Kim Reyes, Benefits Counselor, Appalachian Council of Governments 

If you have Original Medicare, there is a great possibility that your medical providers have begun participating in an Accountable Care Organization (ACO). An ACO is a group of doctors and other health care providers who agree to work together with Medicare to give you more coordinated services and care. ACO’s are designed to help your doctors and primary care providers communicate closely with your other health care providers so that quality care can better meet your needs.

As a Medicare beneficiary, you have a right to restrict which information is shared in the ACO, and data sharing preferences can be changed at any time by calling Medicare (1-800-633-4227).

With baby boomers entering retirement age, the costs of the Medicare program for elderly and disabled Americans are expected to soar. ACOs would make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work, they would have to seamlessly share information such as diagnostic testing information thus, eliminating the costs of duplication of diagnostic procedures to the consumers and to Medicare. The ACO concept may also be used in the private or commercial insurance arena, thus offering a cost savings to the consumer and the insurance companies. Medical providers who participate in ACO’s could receive compensation based on the money savings provided to Medicare and the consumer.

Medical practices are required to inform their patients if they are participating in an ACO. Patients may likely see posters in the doctor’s offices or may have received correspondence from medical providers with this information. As a Medicare beneficiary, you have a right to restrict which information is shared in the ACO, and data sharing preferences can be changed at any time by calling Medicare (1-800-633-4227).

Medicare benefits, services and costs and protections will remain the same for consumers whether their providers participate in an ACO or not. Someone who is covered by Original Medicare still has the right to visit and get care from any doctor or hospital that accepts Medicare at any time, the same way they do now. Accountable Care Organizations (ACOs) are one way that Medicare is working to better coordinate your care.

If you need more information, you may visit Medicare.gov, call your doctor’s office, or you may call Medicare (1-800-633-4227).

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