Medicare Chronic Care Management

The Centers for Medicare and Medicaid Services (CMS) recognizes the importance of Medicare chronic care management. According to CMS, more than two-thirds of Medicare beneficiaries nationwide have at least two chronic conditions, and nearly 14% have more than six chronic conditions.

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Patients with two or more chronic health conditions need chronic care services as maintaining their conditions can be unbearable. Chronic care services help beneficiaries with a higher risk of decline or death due to their conditions.

Below, we discuss all the details surrounding managing your chronic conditions. We’ll review eligibility, programs, and doctors that can bill.

Who Qualifies for Medicare Chronic Care Management?

You must be eligible for Original Medicare to have the federal insurance program cover your Chronic Care Management. Otherwise, you’ll need to consult your health plan for your options.

You’re eligible for Medicare’s Chronic Care Management Services if you suffer from two or more chronic conditions. These conditions must be expected to last at least 12 months or until indefinitely.

Also, if eligible, you should take advantage of the benefits Medicare has to offer. When you have chronic issues, the more care you have, the less likely complications will arise.

Some of the most prevalent chronic conditions include:

Management services can include:

  • Creating a plan of care with your doctor
  • At least 20 minutes of care management health services per month
  • Frequent check-ins with your doctor
  • Emergency access to health care providers

Does Medicare Pay for Chronic Care Management?

Medicare can pay for your doctor’s help in managing your chronic conditions. Chronic care services will fall under your Part B benefits.

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You will need to pay for your Medicare Part B deductible, coinsurance, and copays. If you have a Medigap plan (Medicare Supplement plan), you may pay even less.

Since Medicare covers these services, a Medicare Advantage plan will also cover you when you need this type of care.

The goal of this program is to give you high-quality, coordinated care that will help you gain better health.

Medicare Advantage Chronic Care Management

Medicare Advantage cover chronic care management when deemed medically necessary and the patient has two or more chronic health conditions. Medicare Advantage will provide all the benefits of Original Medicare. However, your plan may also provide additional benefits depending on the plan and carrier you choose to enroll in.

Medicare Advantage plans can provide clients with additional health coverage on top of Original Medicare benefits. Thus, you may enroll in a plan with wider chronic care management coverage.

Practitioners Who Can Bill for Medicare Chronic Care Management

To be covered by Medicare, the doctor or facility you use to care for your chronic condition must participate in and accept Medicare.

The following medical professionals can bill for Chronic Care:

  • Midwives
  • Nurse Specialists
  • Physician Assistants
  • Nurse Practitioners

Doctors that can’t bill for these services include:

  • Podiatrists
  • Limited-License Physicians
  • Dentists
  • Psychologists

How to Qualify for Chronic Care Management with Medicare

To enroll in chronic care management, you need to meet with your doctor. Typically, this requires an in-person visit, but you can talk to your doctor about your options.

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After your doctor visit, you will need to give consent to start getting managed care. Finally, you and your doctor will form an in-depth care plan for your future.

How to Get Medicare Coverage for Chronic Care Management

Chronic health conditions can cause stress and cost money. Thankfully, Medigap plans can help with these extra costs.

While Medicare covers many of your medical needs, it doesn't cover every cost you'll face. When you enroll in a Medigap plan, you can get help with copays, deductibles, and coinsurance.

Alternatively, Medicare Advantage Chronic Care Management may work best for some. Our team is here to walk you through what these plans cover and provide you with further information.

Call our team of agents today at the number above for a free quote. You can also complete an online rate form and have us reach out to you.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Medicare Chronic Care Management

  1. I have had several DVT and 3 blood clots in my legs. I am now 70 and my first vein stripped when I was 30 years. My legs swell have varicose veins, hurt and walking is difficult. Approximately 60% of my weight is fat on my legs that will not come off no matter how much I diet and excercise. The leg fat makes circulation to my hear more difficult. Will Medicare pay for liposuction on my legs. At my age I am not wanting this for appearances. I would like better health and less medical procedures.

    1. Hi Diane! I would discuss this with your doctor. If they feel liposuction is medically necessary, Medicare may cover the cost.


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