Does Medicare Cover Chronic Care Management (CCM)?

Chronic care management services are meant to help people who have multiple chronic conditions that require medical treatment, like cancer or diabetes. According to the Centers for Disease Control and Prevention, chronic diseases are among the leading causes of death and disability in the United States, with heart disease listed as the No. 1 cause of death and cancer the No. 2. Medicare will help pay for the creation and implementation of an all-encompassing chronic care management (CCM) plan to manage these conditions.

If you are dealing with chronic conditions, this service allows health care professionals to not only better manage your health but also extend your care beyond regular doctor’s visits and provide consistent support and assistance. Clearly defining the scope and challenges of your conditions helps your health care provider come up with the most effective plan to manage and treat them.

If you have multiple chronic conditions that require the development of a comprehensive care plan, your health care provider will prepare and oversee it. They will also review and help manage your medications, support you through appointments or treatments and provide round-the-clock access to health care professionals for any urgent care needs.

To qualify for chronic care management, you must have two chronic conditions that are both expected to last at least a year or for the rest of your life. In order to be eligible, these conditions must put you at risk of death, exacerbation, decompensation or functional decline.

In the medical field, exacerbation means a rapidly progressive increase in the severity of a condition that requires urgent care. Decompensation occurs when a part of your body that had been working begins to fail, and functional decline is loss of mental or physical abilities.

The definition of a chronic condition can vary, so even if your condition is not on this list, it may still be a Medicare-covered condition. Chronic conditions are often a result of activities such as tobacco use, excessive alcohol consumption or poor nutrition and eating habits. According to a 2022 article from the National Association of Chronic Disease Directors, nearly 60% of adults in the United States have at least one chronic disease.

A Medicare Advantage plan, also known as Medicare Part C, is an alternative to Original Medicare provided by private insurance companies. Medicare Advantage plans include everything covered under Medicare Part A and B, as well as additional benefits. This means that chronic care management is covered.

To receive chronic care management services, you will have to pay coinsurance. Medicare Part B typically covers 80% of the Medicare-approved cost for most items and services, leaving you to pay 20% after you’ve met your deductible, which is $226 for 2023.

You may have to pay a monthly fee to receive these services, but your fee could be covered if you have supplemental insurance or Medicaid.