What Is Medicare Chronic Care Management?
Key Takeaways
- Medicare Chronic Care Management is for Medicare-eligible people with two or more serious chronic conditions.
- Chronic Care Management plans are paid for by Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. .
- Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans also cover the cost of CCMs.
- All the medical services you need for your conditions, including prescriptions and appointments, are overseen by one healthcare provider.
- CCMs provide access to a healthcare provider on a 24-hour, seven day a week basis.
Medicare chronic care management (CCM) is a plan designed to help people with two or more chronic conditions better manage their health. CCM plans provide additional resources to Original Medicare and Medicare Advantage plans, which in turn help reduce healthcare complications for beneficiaries. This article will explore how Medicare CCM works, who qualifies, and how to apply.
Managing Chronic Conditions with Medicare
According to the CDC, chronic illnesses are the top causes of death in the United States. Original Medicare and Medicare Advantage plans offer coverage for hospital stays, doctor visits, and medications. However, many patients struggle to coordinate care to manage complex health needs.
Medicare chronic care management can help take the responsibility of care coordination off of beneficiaries. CCM focuses on considering all aspects of a patient’s care, helping beneficiaries avoid gaps in treatment and unnecessary hospitalizations.
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Understanding Medicare Chronic Care Management Plans
Medicare chronic care management plans work with providers to organize medication needs and other resources to coordinate care. With CCM, patients benefit from having a dedicated care team to develop a personalized care plan, monitor their progress, and adjust treatments as needed.
CCM aims to simplify healthcare management for individuals with chronic illnesses, helping them maintain independence and achieve better health outcomes.
Eligibility Criteria for Medicare Chronic Care Management Plans
- Patients must be enrolled in at least Medicare Part B
- Patients must have two or more chronic conditions that are expected to last at least 12 months (or until end of life), or these conditions must increase risk of death
- A doctor or other qualified practitioner must deem patients eligible for CCM services in person during an evaluation and management visit or an annual wellness visit
- Patients must consent to CCM services before they are rendered
What Do Medicare Chronic Care Management Plans Cover?
Medicare CCM plans offer a variety of services to address ongoing healthcare needs, including:
- 24/7 access to a healthcare professional via phone or electronic communication.
- Monthly care coordination, including at least 30 minutes of dedicated time from your care team per calendar month.
- A comprehensive electronic care record, documenting your conditions, treatments, and medications.
- A personalized care plan with clearly defined goals and strategies.
- Coordination between all your healthcare providers to avoid conflicting treatments.
- Support for accessing community resources, such as transportation or meal services.
These services aim to streamline communication and care tactics between all of the beneficiary’s health practitioners and caregivers.
How Medicare Covers CCM Plans
CCM services are covered under Medicare Part B. The annual Part B deductible applies ($257 in 2025). Once reached, beneficiaries pay for 20% of the service costs out of pocket, while Medicare covers the remaining 80%. Those with Medicare Advantage plans may have different deductibles and coinsurance rates, but all Medicare Advantage plans must cover CCM as well as Original Medicare.
Patients must receive CCM services from a Medicare-approved healthcare provider. To ensure coverage, confirm with your provider that they accept Medicare and will bill appropriately for CCM services.
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Chronic Care Management Plans vs. C-SNP
A Chronic Special Needs Plan (C-SNP) is a type of Medicare Advantage plan designed specifically for beneficiaries diagnosed with certain chronic conditions. Unlike CCM, which is an add-on service, a C-SNP is an all-in-one Medicare plan that provides medical, prescription drug, and other benefits tailored to specific illnesses.
You can have a CCM plan and a C-SNP at the same time if you are eligible for both. While CCM focuses on care coordination, a C-SNP provides broader coverage for specific health needs.
How to Apply for Chronic Care Management
- Schedule a consultation. Meet with your primary care provider to discuss your eligibility and chronic conditions.
- Authorize your provider to enroll you in CCM services. This will involve signing a consent form to allow them to bill Medicare on your behalf.
- Develop a care plan with your provider. They should detail your health goals, treatments, and necessary resources.
- Stay engaged. Participate in monthly check-ins and utilize 24/7 access to your care team. Be proactive about asking questions to ensure you fully understand how CCM can benefit your health.
Putting It All Together
Medicare chronic care management is valuable for individuals managing multiple chronic conditions. It provides personalized care coordination, ongoing support, and access to helpful resources. If you’re curious about applying for CCM services, your primary physician can determine your eligibility.
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Sources
- Chronic Care Management Services (2019). CMS.gov.
- About Chronic Diseases. CDC.gov.