Medicare

I am covered by traditional Medicare and was recently notified by my doctor that she is participating in an “ACO” created by the ACA. What is an ACO and how does this affect me?

The ACA created a new Medicare payment model, called the Accountable Care Organization, or ACO, as part of an ongoing effort to try to lower costs and improve the quality of care in Medicare.  ACOs are groups of doctors, hospitals, and other health care providers that form partnerships to collaborate and share accountability for the quality and cost of care delivered to their patients.  There are several types of ACOs, and Medicare’s payments to them vary based on their success in meeting quality and spending goals.  If any of your doctors or clinical practitioners are participating in a Medicare ACO, you still have access to all your Medicare benefits and may continue to see any Medicare provider that you choose.  All providers are required to notify you of their participation in a Medicare ACO.

For more information about Medicare ACOs, see Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments.

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While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.