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Chronic Care Management Medicare Coverage

Many individuals struggle with conditions that don’t improve quickly. These chronic conditions may require ongoing medical care and support.

Does Medicare cover chronic conditions? Most of the time, yes. Medicare considers care for ailments such as arthritis and diabetes to be a covered service. However, it’s important to know the limitations of Medicare chronic care management.

What Does Medicare Define as Chronic Condition Management?

To obtain Medicare chronic care management coverage, several circumstances must be met.

Medicare must recognize the condition as an approvable condition for this type of care. The chronic condition you have must be recognized by the Centers for Medicare & Medicaid Services . Generally, this includes conditions like:

  • Arthritis

  • Kidney disease

  • Diabetes

  • Heart failure

Keep in mind that the amount of coverage and care provided will vary depending on the condition itself. This falls under the coverage provided by Medicare Part A and Medicare Part B. If you have Medicare Part C — also known as the Medicare Advantage Plan — the coverage you have will depend on your policy details, which may differ from one provider to the next. Be sure to verify your coverage by contacting your plan administrator.

Check the Medicare chronic conditions list to determine if care is available. Then, reach out to your provider to verify coverage of the services you wish to obtain.

Additional Requirements for Chronic Condition Management

If you want to take part in Medicare’s chronic care management program, other requirements include:

  • You must suffer from two or more serious chronic conditions that are expected to last a year or more.

  • You must need at least 20 minutes per month of care management services for your condition.

If this applies, you must sign an agreement that allows you to qualify for chronic care treatment and develop a treatment plan.

Generally, Medicare Part B covers the costs associated with chronic conditions. Your regular benefits, deductibles and coinsurance costs still apply. You may be able to use supplemental coverage to pay for additional out-of-pocket expenses, too.

If you agree to chronic care treatment, your provider will develop a treatment plan that outlines support services, medication management and potential urgent care needs
to meet your health goals.

The Medicare Special Needs Plan

A Medicare chronic care Special Needs Plan requires you to meet special requirements. If you meet those eligibility requirements, you may be able to obtain the same services provided under Medicare Advantage plans. Additionally, a Special Needs Plan may provide additional coverage for services depending on the group you are in, such as more days in the hospital. Your plan will provide exact details about what type of coverage may be available to you.

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