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Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other providersA person or organization that provides health care-related services, like a doctor, hospital, or clinic.
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who work together to provide care for people in regular MedicareThe federal health program that provides health care benefits for people age 65 years or older, people age 65 years or younger with certain disabilities, and people with certain diseases.
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  • You can keep your doctors and other providers.
  • You can see any provider who takes Medicare.
  • You still get your Medi-CalCalifornia’s Medicaid program. Medi-Cal offers health coverage for low-income Californians.
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    benefitsMedicare and Medi-Cal cover health care benefits, which are medically-necessary services that you get from your health plan and/or individual providers.
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    like you do today.
  • Providers are rewarded for giving you high-quality care.
My Choices 
Benefits 

Benefits

  • You keep your Medicare the same, including doctors, hospitals, prescription drugs, lab tests and X-rays, and some medical equipmentThis is equipment ordered or prescribed by your doctor to use at home.
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    . You can see any Medicare provider you want, even if they are not part of your ACO just like with original Medicare.
  • You keep your Medi-Cal the same. You don’t lose any of your Medi-Cal benefits, you continue to receive those benefits and services like you do today. This includes some medical equipment and supplies, as well as your long-term services and supportsA variety of services aimed at helping people with daily living activities.
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    like In-Home Supportive Services (IHSS)The IHSS program provides in-home care for people who cannot safely remain in their own homes without assistance.
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    or adult day centersCenters that provide daytime health care, such as nursing, therapies, social activities, and meals for people who don’t need care 24/7.
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    . Medi-Cal still covers your co-paysSome health plans require you to pay “cost-sharing” – or a part of the cost of your covered health care services.
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    and other cost sharingSome health plans require you to pay “cost-sharing” – or a part of the cost of your covered health care services.
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  • Your Medicare providers are given incentives by Medicare to provide you high-quality, efficient care. This means:
    • Your providers, like your doctors and hospitals, will work together to make sure you’re getting the care you need. They will share information, so you don’t have to repeat tests or other care.
    • They will talk to you about the care you want, so that you can make your own choices.
    • Your providers might give you extra help making sure you are getting all the care you need, like arranging for transportationMedicare covers emergency ambulance services. Medi-Cal provides transportation to non-emergency, medically-necessary services, like doctor visits or to pick up a prescription.
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      to medical services.

Considerations

  • ACOs don’t include any of your Medi-Cal benefits and aren’t responsible for helping you get your Medi-Cal benefits.
    • If you need help with your Medi-Cal covered medical suppliesSupplies that are typically disposable, single use, medically-related, and often ordered or prescribed by a physician.
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      , equipment, or long-term services and supports, an ACO may not provide enough help.
    • If you mostly need help with your medical care, an ACO may be a good fit for you.

To qualify for an ACO, you must:

  • Have traditional Medicare.
  • Not be in a Medicare health plan.
Success Stories 
Next Steps 

Ready to take the next step?

Download Helpful Tools

Use these tools to understand your next steps and organize your health information:

Download Next Steps Checklist

Download Health Profile Worksheet

Contact Help Services

Visit our Get Help page for links and phone numbers to people who can help you understand your Medicare and Medi-Cal benefits and assist you in choosing a care option.

Explore More About ACOs

Accountable Care Organizations: General Information and a quick overview video.

Accountable Care Organizations. Centers for Medicare and Medicaid Services

National Association of ACOs (NAACOS)

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