Medicare Chronic Care Management (CCM) helps members with two or more chronic conditions receive coordinated care outside regular office visits and reach their treatment goals.
According to the Centers for Medicare and Medicaid Services (CMMS), CCM is for Medicare members with two or more serious chronic conditions that are expected to last at least 12 months.
With Medicare Chronic Care Management, one healthcare professional can manage your medications, appointments, and services.
CCM is designed to help organize your medications, appointments, and therapies by connecting the dots between your care for different chronic conditions.
Under CCM, a healthcare professional will help you make a comprehensive care plan. The plan will include:
- your health problems
- your treatment goals
- your medications
- the care you need, including symptom management and planned interventions
- a cognitive and functional assessment
- a caregiver assessment
- any community services you need
- the healthcare providers treating you
You’ll sign an agreement with your healthcare professional to manage this plan. Once the plan is in place, your healthcare professional will be able to:
- manage your care across providers
- coordinate your care between hospitals, pharmacies, and clinics
- manage the medications you take
- provide round-the-clock access to emergency care
- teach you about your conditions and your medications
- help you meet your health goals
- manage community services such as transportation to appointments
- provide at least 20 minutes a month of dedicated CCM services
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 your healthcare professional. They can help you feel more in control of your health.
Medicare Chronic Care Management is covered under Medicare Part B.
The first step to getting CCM is visiting a provider. Your CCM provider can be any Medicare-approved provider, including:
- nurse practitioners
- physician’s assistants
You’ll need to make this visit face-to-face. You can ask your primary care physician if they provide CCM services. In many cases, your provider might be the one to suggest a CCM to you 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 member of their team 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 will then make sure Medicare covers your CCM services once you’ve had your first appointment and have signed your CCM plan.
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.
Many conditions can qualify you for a CCM plan. Common chronic conditions include:
- heart and cardiovascular disease
- arthritis, including osteoarthritis and rheumatoid arthritis
- high blood pressure
- mental health conditions, such as depression
- Alzheimer’s disease and dementia
- chronic obstructive pulmonary disease (COPD)
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 cost of service. You’ll be responsible for a coinsurance payment of 20%. This means that if an appointment costs $50, you’ll pay $10, and Medicare Part B will pay $40.
Medicare Part B also has a monthly premium for most people. The standard Part B premium in 2023 is $164.90.
Your costs might look different. For example, if you’re enrolled in a Medigap plan, it will cover your coinsurance costs. You might not have to pay anything for your CCM if you have both Medicare and Medicaid coverage.
Medicare Advantage plans cover all Medicare Parts A and B services, including CCM plans. Your costs will probably be different under an 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.
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.
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 every year 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 or as late as 3 months after. You’ll have to pay a late enrollment fee if you wait longer. You can enroll in Medicare before you turn 65 if you have a disability and have received Social Security for two years.
Medicare CCM is a great way for people with multiple chronic conditions to get help managing their health.
With a CCM, a healthcare professional will coordinate the services you need to manage your conditions and reach your health goals.
Medicare Part B and many Medicare Advantage plans cover CCM plans.