Pioneer ACO Model Voluntary Alignment Frequently Asked Questions

Some Medicare beneficiaries may have received a letter and form in the mail asking them to confirm where they are receiving their medical care. These letters and forms are associated with a Pioneer Accountable Care Organization (Pioneer ACO).Completion of the form is optional for beneficiaries. Even if a beneficiary does not complete the form, his or her Medicare benefits will not change and they can continue to see their doctor of choice.

 

What is a Pioneer ACO?

Pioneer ACOs are groups of doctors, hospitals, and other health care professionals, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care may include talking with your different medical providers to manage your medications and may also include providing you with certain preventive care services. ACO services vary, but can include providing transportation for doctor appointments or providing you with a list of resources in your community where you can get other services you may want or need.

 

Why did beneficiaries receive a letter and form?

Beneficiaries received a letter and form if the doctors they are seeing are affiliated with a Pioneer ACO participating in the voluntary alignment initiative. The letters asks beneficiaries to confirm their relationship with their physician or group practice. This confirmation would allow the beneficiary’s doctor to better work with the Pioneer ACO they are affiliated with to provide better coordinated services and care. Even if a beneficiary confirmed their group practice, they still remain free to see any other doctor of their choosing.

 

Why do the letters refer to an organization the beneficiary may have never heard of?

The name of the Pioneer ACO is the name of the entity that works with a number of different participating medical providers, such as a primary care practice, a hospital, a specialist, a pharmacy, and other Medicare-enrolled providers to provide care for patients. You may be familiar with the doctor participating in the Pioneer ACO, but not with the name of the Pioneer ACO itself. If you have questions about the Pioneer ACO listed on your letter and form, you may call their number that was provided in the letter.

 

Is Medicare changing a beneficiary's doctor?

No. Receiving or signing the form does not affect a beneficiary’s Medicare benefits in any way. Medicare is not changing any beneficiary’s doctor and beneficiaries can still see any doctor they choose. Completing the form is meant to help a beneficiary’s doctor better coordinate their care by confirming with the Pioneer ACO where the main place they go for medical care is.

 

The group practice listed on the form is incorrect. What should I do?

If the doctor or group practice listed on the form is not your main doctor, do not sign the form.   not completing the form will not change your existing benefits and you will continue to receive your medical services at your current group practice. You may contact the Pioneer ACO (using the phone number provided in the letter) to request a corrected form with the name of your main doctor or group practice.

 

What happens if the beneficiary doesn't fill out the form?

The form is optional. If they choose to complete the form or if they choose not to complete the form, their Medicare benefits will not change in any way and they can still see any doctor of their choosing.

 

How can the beneficiary change their decision after they have mailed the form?

If after completing the form you change your mind about whether you will want to receive medical care from the doctor or group practice listed on the form, you can contact the Pioneer ACO using the phone number on the letter that accompanied the form to reverse your previous decision.

 

Why should the beneficiary fill out this form?

Yes, both the letter and form received from a doctor or an ACO are legitimate Medicare documents and part of an ongoing Medicare initiative. An ACO is a group of doctors and other health care professionals that work together to coordinate the care of their patients. Pioneer ACOs provide additional services to benefit their patients. If a beneficiary received a form it means that a Pioneer ACO has likely been responsible for coordinating his/her care in the past. If a beneficiary wants the doctors currently participating in a Pioneer ACO to continue coordinating his/her care in the future, the beneficiary may sign the form and return it to the Pioneer ACO. If a beneficiary is unfamiliar with the services the Pioneer ACO offers, he/she can contact their Pioneer ACO for more information on its services.

 

What if I have additional questions, who may I contact?

You may call 1-800-MEDICARE and have your questions answered. If 1-800-MEDICARE is unable to answer your questions or have any suggestions or comments please contact the Pioneer Questions inbox at PioneerQuestions@cms.hhs.gov.

 

Where can the beneficiary find out more information about the Pioneer ACO Model?

Medicare wants to ensure that the beneficiary’s questions are answered before they sign the form. If they have any questions about Pioneer ACOs, they can ask their doctor, contact the Pioneer ACO by using the phone number on the form, or call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. They can also get more information online at the website below: