Does Medicare Cover Chronic Care Management (CCM)?
Medicare may help pay for chronic care management services. This includes the creation and facilitation of a comprehensive plan to help treat and manage your chronic conditions. You will likely have to pay a monthly fee for this service along with coinsurance after you pay your deductible.
- Written by Christian Simmons
Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.Read More
- Edited ByLee Williams
Senior Financial Editor
Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.Read More
- Published: May 17, 2021
- Updated: January 17, 2023
- 3 min read time
- This page features 11 Cited Research Articles
- Edited By
What Is Chronic Care Management?
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.
- Your health problems
- Your treatment goals
- Your medications
- Community services that you need
- Any other relevant health information
- The overall care that you need
- How your care will be coordinated
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.
Eligibility for Chronic Care Management with Medicare
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.
- Alzheimer’s disease
- Atrial fibrillation
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.
Medicare Advantage Coverage
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.
Chronic Care Management Costs Under Medicare
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.
11 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022). Costs. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- Centers for Disease Control and Prevention. (2022, September 6). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
- Centers for Disease Control and Prevention. (2022, July 21). About Chronic Diseases. Retrieved from https://www.cdc.gov/chronicdisease/about/index.htm
- Department of Health & Human Services. (2021, August 3). What Is Medicare Part C? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
- Hoffman, D. (2022). Commentary on Chronic Disease Prevention in 2022. Retrieved from https://chronicdisease.org/wp-content/uploads/2022/04/FS_ChronicDiseaseCommentary2022FINAL.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, December 23). Chronic Care Management. Retrieved from https://web.archive.org/web/20220428014812/https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management
- U.S. Centers for Medicare & Medicaid Services. (2019, July). Chronic Care Management Services. Retrieved from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf
- Bernell, S., & Howard, S.W. (2016, August 2). Use Your Words Carefully: What Is a Chronic Disease? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969287/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Chronic Care Management Services. Retrieved from https://www.medicare.gov/coverage/chronic-care-management-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Part B Costs. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
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