Managing Chronic Conditions Under Medicare

If you are managing two or more chronic conditions, Medicare has a program specifically designed to help, and most people have never heard of it.

It is called Chronic Care Management (CCM), and it is a covered benefit under Medicare Part B.

Who Qualifies? 

You may be eligible for CCM if you have two or more chronic conditions that:

• Are expected to last at least 12 months or for the rest of your life

• Place you at greater risk of serious health decline or death

Common qualifying conditions include diabetes, heart disease, high blood pressure, COPD, arthritis, depression, Alzheimer's disease, chronic kidney disease, cancer, and many others. Medicare does not limit the list, and any two conditions that meet the criteria can qualify you.

What Does CCM Include?

Once enrolled, a single provider coordinates your care across all your conditions. This includes:

• A comprehensive, personalized care plan covering all your chronic conditions

• Coordination among all your doctors and specialists

• Medication review to check for harmful interactions

• Help accessing preventive services and community resources such as transportation to appointments

• A direct point of contact between appointments for questions and concerns

• Regular updates to your care plan as your needs change

What Does it Cost?

• CCM is covered under Medicare Part B

• Medicare pays 80%; you are typically responsible for a 20% coinsurance

• If you have a Medicare Supplement policy, it may cover that 20% entirely

• If you have both Medicare and Medicaid, you may owe nothing

• If you have a Medicare Advantage plan, cost-sharing varies by plan, and you may be eligible for a Chronic Special Needs Plan (C-SNP). Your SGIA Benefit Consultant can help you determine if this may be right for you.

How Do You Get Started?

• Talk to your primary care physician, nurse practitioner, or physician assistant

• Ask if they offer CCM services

• You will begin with an in-person visit to discuss your conditions and create your care plan

• You sign a CCM enrollment form before services begin

• You can cancel or transfer to another provider at any time

Advanced Primary Care Management (APCM)

Medicare now also covers Advanced Primary Care Management (APCM) services, which are similar to CCM but available to anyone on Medicare, even with just one chronic condition. Providers must give you 24/7 access to your care team. Ask your doctor whether CCM or APCM is the right fit for your situation.

Your SGIA Benefit Consultant can help you understand whether either program is right for you. Call us at 888-284-3314 or visit our website sgiamedicare.com.