Medicare Shared Savings Program Beneficiary Rights and Protections


A beneficiary aligned to an ACO (like the Medicare Shared Savings Program) maintains complete freedom to visit any health care provider accepting Medicare, just as all Medicare beneficiaries participating in original, fee-for-service Medicare do. These beneficiaries do not need a referral to see a specialist outside the ACO. Unlike a managed care arrangement-- like an HMO or a Medicare Advantage plan-- a beneficiary aligned to an ACO is free to see any health care provider accepting Medicare at any time. If you are searching for a specialist or facility, we welcome you to search Banner Health Network’s Provider Search. These are additional doctors, providers and entities which are committed to the high quality delivery of efficient healthcare. If you would like some help in finding providers, you may also call us at BHN Nurse On-Call at 602-747-7990 or outside of Maricopa County call 888-747-7990.

In addition, beneficiaries maintain all the benefits to which they are entitled in original, fee-for-service Medicare. Beneficiaries have direct channels of communication to the Centers for Medicare and Medicaid Services (CMS) to ask questions and relay concerns. Through the initial notice of participation, beneficiaries will be informed that they can call 1-800 MEDICARE (1-800-633-4227) at any time to ask questions about the program, alert CMS of any concerns they may have about the ACO. Beneficiaries will also be surveyed each year to assess their experience.

 

Medicare Shared Savings Program ACO Preferences

Under the Medicare Shared Savings Program ACO Model, beneficiaries do not enroll in an ACO. Primary care providers and other health care providers make the decision to participate in ACOs, meaning a beneficiary will not need to take proactive action to receive the benefits offered through an ACO. Participating providers are required to notify beneficiaries of their participation, ensuring the beneficiary is aware of the arrangement, and his or her rights described in this document. You will see a written notice in the offices of the providers who are participating. Beneficiaries can call 1-800 MEDICARE (1-800-633-4227) at any time to ask questions about the program, alert CMS of any concerns they may have about the ACO, or to opt out of data sharing with the ACO.