The short answer
Medicare covers a service called Chronic Care Management (CCM) for people who have two or more chronic conditions expected to last at least a year — things like diabetes, heart disease, COPD, arthritis, or high blood pressure. It pays your care team to coordinate your care between office visits: managing your medications, keeping your care plan current, and being reachable when something comes up.
It's one of the most underused benefits in Medicare, mostly because patients don't know to ask for it and busy practices don't always offer it. If you're juggling several conditions and several doctors, it can be genuinely helpful.
What you actually get
Under CCM, a member of your care team spends time each month on your care outside of a face-to-face visit. That includes maintaining a comprehensive care plan you can have a copy of, coordinating between your specialists and your primary doctor, helping manage prescriptions and refills, and giving you a way to reach the practice about your ongoing conditions.
The idea is to catch small problems before they become hospital stays. For someone with COPD and heart failure, for example, steady management between visits is exactly what keeps a bad week from turning into an emergency. Our guide to Medicare coverage for COPD covers how ongoing management fits in.
What it costs
CCM is a Part B service, so there's normally a small monthly coinsurance unless you have coverage that fills it — a Medicare Supplement, for instance, or a Medicare Advantage plan that handles cost-sharing differently. The monthly cost is modest, and for many people the coordination is worth it.
If you qualify for a Medicare Savings Program or have full Medicaid, that cost-sharing may be covered entirely. It's worth asking your doctor's office what your share would be before deciding.
How to ask for it
You have to enroll in CCM with a provider — usually your primary care doctor — and they'll explain the care plan and how the monthly check-ins work. Only one practitioner can bill for your CCM at a time, so it makes sense to set it up with the doctor who manages most of your care.
If you have multiple chronic conditions and feel like nobody is quite coordinating the whole picture, this is the benefit to bring up at your next visit. Our Medicare basics overview explains how Part B services like this fit into your coverage.
Frequently Asked Questions
Who qualifies for Chronic Care Management?
People with Medicare who have two or more chronic conditions expected to last at least a year and that place them at significant risk. Your provider confirms eligibility and enrolls you in the service.
Does Chronic Care Management cost anything?
It's a Part B service with a small monthly coinsurance unless you have a Medigap plan, Medicare Advantage cost structure, or a Medicare Savings Program that covers it. Ask your provider what your share would be.
What does the monthly service include?
At least 20 minutes of non-visit care coordination per month: maintaining your care plan, managing medications, coordinating between your doctors, and giving you a way to reach the practice about your conditions.
How do I sign up for CCM?
Ask your primary care provider. You enroll with one practitioner who manages your chronic care, and they set up the care plan and monthly check-ins.
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