Does Medicare Cover Transitional Care Management Services?
Medicare Part B covers transitional care management (TCM) for 30 days when you are returning to your home or community from a stay in a facility. After you meet your Part B deductible, you will pay a 20 percent coinsurance of the Medicare-approved cost of the service.
What Does Original Medicare Cover for Transitional Care?
Transitional care management is available through Medicare when you are returning home from a stay in the hospital or other similar facility.
According to the U.S. National Library of Medicine, TCM is essential for seniors dealing with multiple chronic conditions like arthritis, cancer and diabetes.
Transitional care is also effective if you are recovering from a traumatic condition like a stroke.
- Hospital (inpatients only)
- Skilled nursing facility
- Rehabilitation facility
Transitional care is unlikely to be covered by Medicare Part A since it is a home-based service when you are no longer a hospital inpatient.
Medicare Advantage for Transitional Care Coverage
A Medicare Advantage plan, also known as Medicare Part C, is an alternative coverage option available to beneficiaries. These plans must include everything covered in Part A and Part B, so that you will receive at minimum the same level of coverage from Original Medicare.
Part C includes additional benefits and expanded coverage for many types of services that Medicare offers.
Check with a plan administrator to learn more options for transitional care coverage through a Medicare Advantage plan.
Services Included or Covered Under Transitional Care
Transitional care management lasts for 30 days after facility discharge and includes several services to help you adjust to returning to your home.
A healthcare provider will manage your transition and problem-solve with your family or caretaker to ensure everything is smooth and effective.
Also, you will get an in-person office visit within 14 days of returning home.
The healthcare provider overseeing your transition will also manage your medications and treatments, including scheduling or arranging any follow-up care or services as needed.
You may also be eligible for chronic care management, which is another service that Medicare covers for people dealing with multiple chronic conditions.
Transitional care can have a significant impact on your health if not handled properly. According to the U.S. National Library of Medicine, changing locations after you have received care can lead to miscommunication if the transition is disorganized – which can affect your future treatments, too.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2016, March 17). Frequently Asked Questions About the Medicare Physician Fee Schedule for Transitional Care Management Services. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf
- AARP Public Policy Institute. (2013, March). Recent Medicare Initiatives to Improve Care Coordination and Transitional Care for Chronic Conditions. Retrieved from https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/2013/recent-medicare-initiatives-improve-coordination-transitional-chronic-AARP-ppi-health.pdf
- U.S. National Library of Medicine. (2008, September). Transitional Care: Moving patients from one care center to another. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768550/
- American Academy of Family Physicians. (n.d.). Transitional Care Management. Retrieved from https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/transitional-care-management.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Part B costs. Retrieved from https://www.medicare.gov/your-medicare-costs/part-b-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Transitional care management services. Retrieved from https://www.medicare.gov/coverage/transitional-care-management-services
- U.S. Department of Health & Human Services. (n.d.). What is Medicare Part C? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
- U.S. National Library of Medicine. (2015, October). Exploring Transitional Care: Evidence-Based Strategies for Provider Communication and Reducing Readmissions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606859/