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Medicare & Chronic Care Management


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

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

In the content below we’ll discuss all the details you need to know about managing your chronic conditions. We’ll go over eligibility, programs, and doctors that can bill.

Who Qualifies for Chronic Care Management

You must be eligible for Medicare to have the federal 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 the death of the patient.

Also, if you’re 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

Tip: Chronic care management is not the same as the care coordination you get after an inpatient hospital stay.

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

Since Medicare covers these services, an 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.

Who Can Bill for Chronic Care Management

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 Enroll in 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.

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.

FAQs

Can Medicare Advantage Patients enroll in chronic care management?
This type of care is a Part B benefit. If you’re an Advantage beneficiary, you can enroll in chronic care management if you qualify.
How often can you be billed for chronic care?
Doctors can bill for chronic care once a month. But, only one practitioner can be paid for these services per month.
Why is chronic care management critical?
Chronic care management is critical to those with severe health conditions. It can help patients continuously manage these conditions, potentially reducing pain, and increasing relaxation, mobility, and even lifespan.

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.

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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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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