Medicare covers Chronic Care Management (CCM) for people with two or more chronic conditions to help them manage their care. You may have to pay copayments for this service.

Medicare provides Chronic Care Management (CCM) for people with multiple chronic conditions who have Medicare. Both Original Medicare (parts A and B) and Medicare Advantage (Part C) plans can provide CCM.

If you have CCM, one healthcare professional can manage your medications, appointments, and services.

Keep reading to learn what CCM includes, the eligibility guidelines, and how much it costs.

CCM is designed to help organize your medications, appointments, and therapies into a combined plan and give you a consistent point of contact in your care for multiple chronic conditions.

A CCM provider typically works with you to develop a comprehensive care plan based on your diagnoses and treatment goals across all of your chronic conditions. They use this plan to monitor your conditions and the care you need. If your needs change, they can also revise the plan. This plan also coordinates the care you receive from all of your healthcare professionals.

Your CCM provider is responsible for the following:

  • assessing your needs, whether medical, functional, or psychosocial
  • making sure you can access timely preventive services
  • managing the care you receive from all of the healthcare professionals that help manage your conditions
  • reviewing all of your medications for potential interactions
  • helping you self-manage prescriptions you take at home
  • coordinating care with service providers, such as home care or community-based services, like transportation to appointments
  • coordinating with your other care providers about your needs, and documenting any changes in your needs in your medical record

The number of services your plan includes depends on the severity of your conditions and how much help you need to manage them. CCM services offer personalized attention from a healthcare professional. They can help you feel more in control of your health.

Medicare Chronic Care Management is covered under Medicare Part B.

Medicare has a few eligibility requirements for CCM. A healthcare professional can help you determine if you qualify. In general, if you’re a Medicare beneficiary, you can qualify if you have two or more chronic conditions that both:

  • are expected to last at least 12 months or until your death
  • put you at risk of death, decline, or decompensation

Your CCM needs to be planned and monitored by a Medicare-approved provider.

What health conditions qualify for Medicare Chronic Care Management?

Health conditions that may qualify you for CCM may include:

  • alcohol misuse disorder
  • arthritis
  • asthma
  • Alzheimer’s disease or dementia
  • autism spectrum disorder (ASD)
  • cardiovascular disease, including:
    • atrial fibrillation
    • COPD
    • heart failure
    • ischemic heart disease
    • hyperlipidemia (high cholesterol)
    • hypertension (high blood pressure)
  • cancer, such as breast, colorectal, lung, or prostate cancer
  • chronic kidney disease
  • depression
  • diabetes
  • hepatitis B or C
  • HIV
  • osteoporosis
  • psychotic disorders, such as schizophrenia
  • stroke
  • substance use disorder

However, Medicare doesn’t limit what can be called a chronic condition. Any two conditions that meet the rules can qualify you for a CCM.

CCM is covered under Medicare Part B. This means that Medicare will pay 80% of the service cost, and you’ll be responsible for a 20% coinsurance payment.

Medicare Part B also has a monthly premium for most people. The standard Part B premium in 2024 is $174.70.

However, if you have a Medigap plan, it may cover your coinsurance costs. You might not have to pay anything for your CCM if you have both Medicare and Medicaid coverage.

You can get a CCM by visiting with an eligible healthcare professional. Your CCM provider can be any Medicare-approved provider, including:

  • physicians
  • nurse practitioners
  • physician’s assistants

Before starting a CCM plan, you need to have an initiating face-to-face visit where you discuss CCM. This visit can be during:

  • an annual wellness visit
  • a preventive physical exam
  • a visit to evaluate or manage a health concern

You can ask your physician if they provide CCM services, or they may suggest a CCM if they think you’re a good candidate.

Your first visit will be an evaluation. The CMM provider can then make a care management plan for you. The provider or a team member will go over the plan with you and allow you to ask questions. You can cancel or transfer this plan to another provider at any time. You need to sign this form for your CCM to take effect.

Your CMM provider can ensure Medicare covers your CCM services once you’ve had your first appointment and signed your CCM plan.

Medicare Advantage plans cover all Medicare Parts A and B services, including CCM plans.

But costs may vary depending on your Advantage plan. You might need to pay an additional premium or might have a lower set copayment amount. You can use the Medicare website to search for Advantage plans in your area and see your costs.

You can enroll in CCM anytime after you’ve enrolled in Medicare Part B or a Medicare Advantage Plan. You can’t be enrolled in a CCM if you’re only enrolled in Medicare Part A.

Medicare has several rolling enrollment windows yearly that allow you to change your plan and benefits.

Initial Medicare enrollment occurs around your 65th birthday. You can enroll as early as 3 months before the month of your birthday and up to 3 months after. You may have to pay a late enrollment fee if you wait longer.

You are eligible for Medicare before you turn 65 if you have a disability and have received Social Security for two years.

If you have amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD), you do not need to wait two years before enrolling.

How to know if you’re enrolled in Medicare Chronic Care Management

Your doctor will go over a CCM plan form with you. This form will outline your CCM and the services you’ll receive. You’ll need to sign this form before you’re enrolled in CCM.

CCM is a program offered under Medicare that pays for a provider to help manage your care if you have multiple chronic conditions. The services you receive may depend on how much help you need to manage your care.

You may be eligible if you have two or more chronic conditions that meet Medicare’s eligibility criteria.

You typically have to pay a copayment with Medicare Part B, but these costs may be covered if you have additional coverage, such as a Medigap plan.