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Accountable Care Organizations (ACOs)

Accountable Care Organizations are groups of doctors, hospitals, and other providers that work together to provide care for people in regular Medicare.

  • To qualify for an ACO, you must have traditional (“original”) Medicare and NOT be in a Medicare health plan.
  • You can keep the doctors and other providers you have now. You can see any provider who takes Medicare.
  • You continue to get your Medi-Cal A government program that offers health care coverage for low-income Californians. (Medi-Cal is the federal-state Medicaid program in California.)
    benefitsPayment of health care services and products. Medicare benefits pay for doctor visits, hospital care, prescription drugs, and some behavioral health services.
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    like you do today.
  • Providers are rewarded for giving you high-quality care.

Ready to Enroll >

My Choices 
Benefits 

Benefits

  • You keep your Medicare the same as it is now (including doctors, hospitals, prescription drugs, lab tests and X-rays, and some medical equipmentReusable equipment ordered or prescribed by your doctor for use at home, like walkers, wheelchairs, hospital beds, and more. Also known as durable medical equipment (DME).
    ). You can see any Medicare provider you want, even if they are not part of your ACO—just like with original Medicare.
  • You continue to receive your Medi-Cal benefits and services just like you do today. (This includes some medical equipment and supplies, as well as your long-term services and supportsThe federal program that provides health care benefits for people age 65 years and older as well as people of any age with certain disabilities or diseases.
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    like In-Home Supportive Services (IHSS)IHSS provides in-home care for people who need it to safely live in their own homes.
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    or adult day centersFacilities that provide social activities and meals and sometimes nursing and therapies during the day.
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    .) Medi-Cal still covers your Medicare co-paysA copayment (co-pay) is one type of cost-sharing. You pay a certain amount when you receive a service. For example, you might pay a few dollars when you get a prescription filled.
    and other cost-sharingSome health plans require you to pay a part of the cost of your covered health care services. This is called cost-sharing.
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    .
  • Your Medicare providers are rewarded by Medicare for giving you high-quality, efficient care. This means:
    • Your providers (such as 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 transportationPayment of medically necessary transportation. This can include ambulance, wheelchair van, taxi, ride-share service, or public transportation.
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      to medical services.

Considerations

  • ACOs do not provide any of your Medi-Cal benefits and are not responsible for helping you get your Medi-Cal benefits.
    • If you need help with your Medi-Cal covered medical suppliesMedically related supplies often ordered or prescribed by a doctor. They are typically disposable and used once. They include diabetic test strips, oxygen, and incontinence supplies.
      , 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.
Success Stories 
Next Steps 

How to Enroll

You can enroll by: 

  • Asking your doctor or clinic if they are part of an ACO.
    • Calling your local ACO.
  • Find your local ACO under the “My Choices” tab on this page.

Download Helpful Tools

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

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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