Medicare Chronic Care Management: Eligibility, Costs, and Coverage
If you deal with multiple chronic conditions, you’re not alone. Nearly two-thirds of people on Medicare manage two or more chronic conditions. Managing chronic conditions can be difficult. Keeping track of your medications and booking doctor appointments—all while dealing with symptoms—can get to be too much for people to handle on their own.
Thankfully, Medicare has chronic care management services available for people with two or more serious chronic conditions. These services connect you to a team of healthcare providers to help you manage your conditions. Read on to learn more about these services and how they work.
Key takeaways:
Medicare helps cover chronic care management (CCM), which helps people with multiple chronic conditions coordinate treatments for different conditions.
With chronic care management, you and your team of healthcare providers create a plan to treat your conditions. Your healthcare providers also coordinate medications, appointments, and other support on your behalf.
There is a monthly fee for chronic care management. A Medicare Supplement plan or Medicare Savings Program can help reduce your costs.
What are chronic care management (CCM) services by Medicare?
Many people who are eligible for chronic care management may not even know that it exists. From 2019 to 2023, only about 4% of those eligible were enrolled in chronic care management.
Medicare’s chronic care management services help people with multiple chronic conditions coordinate care and get the personalized support they need through a team of dedicated healthcare providers. People receiving chronic care management services are responsible for paying a monthly fee for the services. Your Part B deductible and Part B coinsurance apply.
Who is eligible for Medicare chronic care management services?
Before you can enroll in chronic care management, you must meet certain eligibility criteria. You are only eligible if you meet all of the following conditions:
You have two or more chronic conditions
Your chronic conditions are expected to last for longer than a year, and they increase your risk of death or serious complications
You must be willing to commit 20 minutes per month for checking in with a healthcare provider over the phone or virtually
You must sign an agreement that explains monthly services for chronic care management
Some examples of chronic conditions that would make you eligible for chronic care management include, but aren’t limited to:
Arthritis
Diabetes
Cancer
Autism spectrum disorders
Asthma
Chronic obstructive pulmonary disease (COPD)
Cardiovascular disease
Hypertension
Depression.
The program accepts a broad range of conditions—ask your doctor if you could be eligible if they offer services.
What does Medicare chronic care management cover?
Chronic care management covers personalized support from a doctor who knows about your health conditions and goals. Together, you’ll create a comprehensive plan of care based on your individual health requirements. Your care plan will include:
A list of your health issues
Goals for treatment
Other healthcare providers involved in your treatment
The medications you take
Symptom management
A list of the community services you use
Any other resources and support needed for care specific to your chronic conditions
In addition to personalized assistance, Medicare covers the following for chronic care management:
20 minute check-in per month
Coordinating medications, specialists and other doctor’s appointments, procedures, testing centers, hospitals, fitness, and more
24/7 emergency access to doctors, caregivers, and other medical support staff
Consistent communication via phone, messaging, web, and other virtual methods
How much does Medicare pay for chronic care management?
There are a few out-of-pocket costs you’ll have to pay for chronic care management, including a monthly copay, Part B deductible, and Part B coinsurance. A Medicare Supplement plan or Medicaid can help pay for these costs.
Just like for regular Medicare-covered services, CCM services are subject to a 20% coinsurance once you meet your Part B deductible. Medicare will pay for 80% of any service received as a part of CCM. If you have a Medicare Supplement plan, you won’t have to pay for the monthly copay.
Care for chronic conditions can be costly in general if you don’t have a Medicare Supplement plan. To reduce your healthcare costs with or without CCM, we recommend exploring Medigap enrollment options. The best time to enroll in a Medigap plan is within the first six months of receiving Medicare. During this time, you cannot be denied a plan based on health conditions.
If you have a Medicare Advantage plan, your out-of-pocket costs can vary for chronic care management services. Consult with your plan for more information. Chronic Condition Special Needs Plans (C-SNPs) also specifically cater to people who have chronic conditions. We can help you explore these special plans.
How to start chronic care management and what to expect
Even though they have many benefits, chronic care management services are not used very often. Many people are unaware of the services! Talk to your doctor or primary care provider and see what they offer for chronic care management. While some doctors may not participate in the program, you can look for a different health care provider to coordinate chronic care management.
If you need help finding a doctor who provides chronic care management services or are wondering if there’s a better Medicare plan out there for you, we’re here to help! Get in touch at 855-900-2427 or schedule a time to chat to make sure you’re getting the best value from your Medicare.