Does Medicare cover chronic care management?

What does Medicare chronic care management include?

Medicare Part B may pay for a doctor or other health care provider to help manage your care for serious chronic conditions, like arthritis or diabetes. Chronic care management includes:

• A comprehensive care plan that lists your health problems and goals, other providers, medications, community services you have and need, and other information about your health.
• 24/7 access for urgent care needs.
• Support when you go from one health care setting to another.
• A review of your medicines and how you take them.
• Help with other chronic care needs.

Who qualifies for Medicare chronic care management?

You must have 2 or more serious chronic conditions, like arthritis and diabetes, that you expect to last at least a year.

To get started, ask your provider if they offer chronic care management services. Your health care provider will ask you to sign an agreement to get this set of services on a monthly basis. If you agree, your provider prepares a care plan for you or your caregiver that explains the care you need and how your providers will coordinate it.

What do I pay for chronic care management?

After you meet the Part B deductible ($283 in 2026), you pay coinsurance of 20% of the Medicare-approved amount for chronic care management, which Medicare covers monthly. What you owe can also depend on other insurance you have, how much your doctor charges and whether your doctor accepts assignment.

How is chronic care management different from Advanced Primary Care Management?

Advanced Primary Care Management is a separate Part B service in which you and your primary care provider (or care team) agree that they'll be your main point of ongoing care and coordinate all your health care needs, including care from other doctors, hospitals and providers. Providers that offer it must provide chronic care management, along with 24/7 access to your care team or provider, a personalized care plan, care coordination, transitional care between settings, medication management and behavioral health integration services.

You give your provider verbal or written consent, and you can stop at any time. Medicare covers Advanced Primary Care Management monthly, and after the Part B deductible you pay 20% of the Medicare-approved amount; many people who have both Medicare and Medicaid pay nothing for these services.

Does Medicare Advantage or Medigap change what I pay?

Medicare Advantage plans include Part A and Part B coverage, and costs and rules vary by plan, so check with your plan; Medicare.gov notes that costs for Advanced Primary Care Management might be different in a Medicare Advantage Plan. A Medigap (Medicare Supplement Insurance) policy helps pay your share of out-of-pocket costs in Original Medicare, like copayments, coinsurance and deductibles. See help paying for Medicare.