One Medical ACO

Frequently Asked Questions

1. What is an Accountable Care Organization (ACO)?

   Medicare has started an initiative where health care providers who share a common set of goals aimed at improving patient care can work together more effectively. An Accountable Care Organization (ACO) brings together a group of doctors, hospitals and/or other healthcare providers who agree to work together with Medicare to provide you with more coordinated care according to your individual medical needs and treatment choices. Learn more about ACO's

2. What’s the relationship between an ACO and Original Medicare?

   An ACO is not an insurance plan. Patients who have Original Medicare and have doctors in an ACO retain all of their rights and privileges under Original Medicare, including the freedom to see any health care provider that accepts Medicare, even if that provider is not part of an ACO. And they can opt out of Medicare sharing certain health information by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

3. Why did One Medical join an ACO?

   One Medical is participating in this initiative because we believe it can bring additional benefits and a better quality of care to our patients. Patients who participate in this initiative may benefit from additional care coordination and preventative services or reduced out-of-pocket expenses.

4. Why did I receive a letter saying my doctor is part of One Medical ACO, LLC?

   Medicare requires an annual beneficiary letter be sent to each patient who’s primary provider is part of the program. There are two ways a patient can become aligned to a primary provider in the program:

   1. The first is called voluntary alignment where a patient actively chooses whether or not to sign a voluntary alignment form designating their primary care provider.
   2. The second is called claims-based alignment. This is an annual process run by Medicare to determine where a patient historically received the majority of their primary care services. If you have historically received the majority of your primary care at a One Medical provider participating in the program, you may be claims-aligned to the program.

5. If I am in the program, can I continue seeing my specialists without needing referrals/authorizations? Can I choose a new primary care provider?

   Yes, your insurance remains Original Medicare, and your benefits do not change. You retain the freedom to seek care from any Medicare provider without any additional need for referrals or authorizations. You have the option to designate a new primary care provider by visiting mymedicare.gov if you choose, but are not required to do so.

6. How can I learn more?

   If you have other questions about the ACO program, you can contact us at 1-888-265-0127, or you may call Medicare at 1-800-MEDICARE.