Does Medicare Pay for Chronic Care Management (CCM)?

• by Lisa Eramo, MA
• January 12, 2024
• Reviewed by John Krahnert

Four in 10 adults have two or more chronic conditions, and managing those conditions isn’t always easy.¹ There are medications to take, specialists to see and various other treatment regimens to follow.

The good news is that Medicare covers a service called chronic care management (CCM) that’s designed to help you succeed. Learning about this important benefit can keep you healthy and out of the hospital.

What is chronic care management?

Chronic care management is a service designed to help you manage your chronic conditions through frequent communication with your doctor and the creation of a personalized care plan that takes your unique physical, mental, cognitive, psychosocial, functional and environmental challenges into consideration.

Examples of chronic conditions include, but aren’t limited to:

• Alzheimer’s disease and related dementia
• Arthritis (including osteoarthritis and rheumatoid arthritis)
• Asthma
• Atrial fibrillation
• Autism spectrum disorders
• Cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Depression
• Diabetes
• Hypertension
• Infectious disease (e.g., HIV or AIDS)

Who is eligible for chronic care management from Medicare?

Medicare may pay for chronic care management if you have two or more chronic conditions that your doctor expects will last at least 12 months and that place you at significant risk of death, acute exacerbation/decompensation or functional decline.

If you’re not sure whether you’re eligible, be sure to ask your doctor.

What does chronic care management include?

When you consent to receive CCM, you may receive on or a few of a whole host of services that Medicare covers.

• First, a dedicated healthcare professional will work with you to develop a comprehensive care plan that includes your health problems and goals, other providers, medications, community services available near you and more.
  
  
• Once developed, they will share that care plan with you as well as all of your other providers to ensure timely, coordinated care.
  
  
• As part of the CCM, you’ll also receive phone or portal check-ins between visits to keep you on track. During these check-ins, you’ll review your medications and discuss how other changes in your life might affect your health, as well as what you need in terms of support to meet your goals.

With CCM, you’ll also receive help with care transitions, care coordination with home- and community-based providers and 24/7 access to your provider for urgent care needs. All in all, it’s at least 20 minutes of services each month designed to help you get the connected care you need.

How can chronic care management help?

For many patients, CCM provides an extra boost of support beyond the face-to-face encounter. Through ongoing communications with your doctor, you’ll be able to take better control over your health and manage your chronic conditions more effectively.

If you want to become more engaged in your health, but you need a little help, CCM may be right for you.

Does Medicare require me to receive chronic care management?

No. It’s optional. You must consent to this service, and you have the right to stop it at any time (effective at the end of the calendar month).

How much will I pay for chronic care management?

If you consent to receive CCM services, you’ll pay a monthly fee, and the Part B deductible and coinsurance will apply.

How can I get started with chronic care management?

Simply ask your doctor. Not every physician provides CCM services, but many do – particularly primary care physicians and internists. They can explain the process in greater detail and determine whether you’re eligible.

Find Medicare Advantage plans that cover chronic care management

Medicare Advantage plans cover everything found in Original Medicare, which means chronic care management will also be covered with these plans. Medicare Advantage plans may also cover benefits not found in Original Medicare. Call to speak with a licensed agent today. 

¹ National Center for Chronic Disease Prevention and Health Promotion. (Jan. 12, 2021). About Chronic Diseases. www.cdc.gov/chronicdisease/about/index.htm.

About the author

Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.

Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.

Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.

 

Website: LisaEramo.com

LinkedIn: Lisa Eramo

Twitter: @Lisa_Eramo

Read less