Frequently Asked Questions
What is Medicare Chronic Care Management?
Chronic Care Management (CCM) is a Medicare Part B benefit for patients with two or more chronic conditions expected to last at least 12 months. It covers at least 20 minutes of non-face-to-face care coordination per month provided by your physician's care team. Services include a comprehensive care plan, medication management, coordination between specialists, 24/7 access to a care team member for urgent needs, and transitional care support after hospitalizations.
Who qualifies for Medicare Chronic Care Management?
You qualify if you have two or more chronic conditions that are expected to last at least 12 months and place you at significant risk of death, acute exacerbation, or functional decline. The conditions can be any combination of common chronic diseases: diabetes, heart disease, COPD, hypertension, arthritis, depression, chronic kidney disease, Alzheimer's disease, and many others. Your physician must enroll you and create a comprehensive care plan.
How much does Chronic Care Management cost?
CCM is billed under Medicare Part B. You pay 20% coinsurance after the Part B deductible — approximately $10-15/month with average Medicare reimbursement rates. With Medigap Plan G, you pay $0. For comparison, patients receiving CCM have an average of $74/month in reduced emergency room visits and hospitalizations — a significant net benefit.
How do I enroll in Chronic Care Management?
Ask your primary care physician: 'Do you offer Chronic Care Management billing? I have [list your conditions] and would like to be enrolled.' Your physician creates a comprehensive care plan documenting your conditions, medications, goals, and care team. You must give written consent before the first month of billing. Not all practices offer CCM — some refer to a care management service that coordinates with your physician.
What does Chronic Care Management include each month?
Each month of CCM includes: at least 20 minutes of care coordination (more in complex months), medication reconciliation and management, coordination between all your care providers, support for preventive care and recommended screenings, care transitions support if you're hospitalized or discharged, self-management education and support, and 24/7 access to a care team member for urgent advice.
If you have two or more chronic conditions, you're likely entitled to a benefit that could dramatically improve your care coordination — and most seniors who qualify have never heard of it. Medicare Chronic Care Management provides monthly care coordination services including medication management, specialist coordination, and 24/7 phone access to your care team. It's covered by Medicare with minimal cost-sharing, and for most patients it pays for itself in reduced emergency visits.
What You Get Each Month
Every month of enrolled CCM includes at minimum:
- Comprehensive care plan: A living document of all your conditions, medications, providers, goals, and care preferences — maintained and updated by your care team
- Medication management: Regular reconciliation of all prescriptions across all providers, checking for interactions and appropriateness
- 24/7 phone access: A care team member is available around the clock for urgent questions — not just a nurse line, but someone familiar with your care plan
- Specialist coordination: Your care team communicates with and coordinates between all your specialists to prevent conflicting treatments
- Care transition support: If you're hospitalized, your CCM care team coordinates your discharge and follow-up to prevent readmission
- Preventive care reminders: Tracking and prompting for recommended screenings, vaccines, and wellness visits
Who Qualifies — The Condition List
Two or more of any of these (or other) chronic conditions for at least 12 months:
How to Enroll — The Exact Conversation
At your next doctor's appointment, say: "I have [name your two or more conditions] and I'd like to know if your practice offers Chronic Care Management billing under Medicare."
If your practice offers it: you give written consent, your doctor creates your care plan, and billing begins. Your care team calls you or you call them at least once monthly for 20+ minutes of care coordination.
If your practice doesn't offer it: ask if they can refer you to a care management service. Some independent CCM providers coordinate with your existing doctors while billing Medicare directly.
What It Costs
Medicare Part B pays approximately $62/month for standard CCM. Your cost is 20% coinsurance — approximately $12.40/month — after your annual Part B deductible. With Medigap Plan G or Plan F: $0/month after your deductible. The average CCM patient experiences reduced ER visits and hospitalizations that far exceed this cost.
- Ask your doctor about CCM at your next appointment — use the exact phrase "Chronic Care Management"
- You must give written consent before billing begins
- You can disenroll at any time if the benefit isn't adding value
- With Medigap Plan G, your CCM cost is essentially $0 after the annual deductible
- This benefit is in addition to all your regular office visits — it doesn't replace them