If you have Medicare, there’s a good chance you have two or more chronic conditions such as arthritis, cancer, diabetes, heart disease or dementia.
Two-thirds of the 57 million Americans with Medicare have two or more chronic illnesses. Having multiple chronic conditions increases the risk of death and functional limitations, decreases quality of life and leads to higher health care spending.
Managing chronic diseases can be difficult, to say the least. You often face multiple visits to one or more doctors; you must take multiple drugs at different times on different days; you have to make extra trips for tests. It can all be a bit overwhelming.
At Medicare, we recognize the challenges you have in managing your conditions, working with your health care providers and trying to stay healthy. Two years ago, we added a new benefit called Chronic Care Management, or CCM. This program provides additional payments to doctors and other providers to help you live with chronic disease.
For example, through the CCM benefit your primary-care doctor will help you keep track of your medical history, medications and all the different health care providers you see. You’ll receive a comprehensive care plan that outlines your treatments and goals.
Additionally, you’ll have 24-hour-a-day, 7-day-a-week access to health care professionals for urgent needs from the comfort of your home.
To be eligible for CCM services, you must be enrolled in Medicare or in both Medicare and Medicaid. And you must have two or more chronic diseases that are expected to last at least 12 months and place you at significant risk of death, acute exacerbation/decompensation or functional decline.
Other examples of chronic conditions include, but are not limited to, asthma, atrial fibrillation, autism spectrum disorder, chronic kidney disease, chronic obstructive pulmonary disease, depression, heart failure, hepatitis, hypertension (high blood pressure), infectious diseases such as HIV/AIDS, ischemic heart disease, osteoporosis, schizophrenia and other psychotic disorders and stroke.
Specific CCM services may include:
• At least 20 minutes a month of chronic care management services;
• Personalized assistance from a dedicated health care professional who will work with you to create your care plan;
• Coordination of care between your pharmacy, specialists, testing centers, hospitals, and more;
• Phone check-ins between visits to keep you on track;
• 24/7 emergency access to a health care professional;
• Expert assistance with setting and meeting your health goals.
How much do CCM services cost? You’ll be responsible for the usual Medicare Part B cost-sharing and may have a deductible or coinsurance/co-pay.
However, many people with Medicare have Medigap supplemental insurance that provides wraparound coverage of CCM cost-sharing.
Ask your doctor about Chronic Care Management and get the connected care you need.
For more information, call 1-800-MEDICARE or visit: go.cms.gov/ccm.
Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).