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No.  Medicare Beneficiaries are “assigned” to an ACO by CMS if the physician who provides the bulk of their primary care services participates in the ACO, or if the Medicare Beneficiary voluntarily designates an ACO participating physician as their primary clinician in MyMedicare.gov. Assignment to the ACO is invisible to the beneficiary.

An ACO is NOT a Medicare Advantage Plan, a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), or an Insurance Company.  Medicare Beneficiaries assigned to an ACO still have Original Medicare (Medicare fee-for-service), and their Medicare benefits, services, rights, and protections don’t change. Beneficiaries still have the right to use any doctor or hospital that accepts Medicare at anytime, the same as they did before being assigned to an ACO.

The goal of the ACO is to support doctors in caring for their Medicare Beneficiaries by making sure they have the most up-to-date information about their patient’s health and care.  Doctors in ACOs have greater access to the expertise, staff, and technologies they need to make sure care is coordinated across all the places their patients get services.  To help ACOs coordinate healthcare better, Medicare shares information about beneficiaries’ care with participating providers.  Sharing data helps make sure all the physicians and advance practice clinicians involved in a beneficiary’s care have access to their health information when and where they need it. This information helps ACOs give better, more coordinated care by keeping track of the care and tests that beneficiaries already had.  It may also make it easier to spot potential problems before they’re more serious.  For beneficiaries and caregivers, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, and more awareness of treatment options for various health conditions.  By working together, ACO participating doctors can do more to monitor the health of Medicare Beneficiaries and make sure they receive the highest quality care.  

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