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Posted on 4. May 2017

New Medicare Help for People with Chronic Illness

By Greg Dill

For patients on Medicare, there’s a good chance they have two or more chronic conditions such as arthritis, cancer, diabetes, heart disease or dementia.

Two-thirds of the 57 million Americans on 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 healthcare spending.

Managing chronic diseases can be difficult, to say the least. Patients often face multiple visits to one or more doctors, they must take multiple drugs at different times on different days and they have to make extra trips for tests. It can all be a bit overwhelming.

At Medicare, we recognize the challenges patients have in managing their conditions, working with their healthcare 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 patients live with chronic disease.

For example, through the CCM benefit, patients’ primary care doctors will help them keep track of their medical history, medications and all the different healthcare providers they see. Patients receive a comprehensive care plan that outlines treatments and goals. Additionally, patients have 24/7 access to healthcare professionals for urgent needs from the comfort of their home.

To be eligible for CCM services, patients must be enrolled in Medicare or in both Medicare and Medicaid. And, they must have two or more chronic diseases that are expected to last at least 12 months and place them 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 healthcare professional who will work with patients to create their care plan;
  • Coordination of care between the pharmacy, specialists, testing centers, hospitals and more;
  • Phone check-ins between visits to keep patients on track;
  • 24/7 emergency access to a healthcare professional;
  • Expert assistance with setting and meeting health goals.

How much do CCM services cost? Patients will 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 may cover CCM cost-sharing.

CCM means having a continuous relationship with a dedicated healthcare professional who knows patients and their history, gives personal attention and helps them make the best choices for their health. CCM gives patients and their loved ones the assistance they need to manage chronic conditions so they can spend more time doing the things they enjoy.

For more information, call (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 (800) MEDICARE (633-4227).

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Comments (3) -

Toby
7:29 AM on Friday, May 05, 2017

When will stiff person syndrome (Moersch Woltman disease) get national attention and acknowledgement.
Chronic, treatable not curable.  IVIG helps but deteriorating my kidneys, win/lose I don't which way to go and after 44+ doctors my primary and neurologist are at a loss to help me.

Marilyn Oliva
5:30 AM on Sunday, May 28, 2017

I will be on Medicare in November .  I need to get a supplemental policy with drug coverage.  I live in Texas and would like to know if there is a particular company that is better covering subq medications like Gamaguard?  It is all very confusing.

toby larson
11:02 AM on Tuesday, November 07, 2017

I use anthem blue cross blue shield advantage with my medicare, no problems. I use Cleveland Clinic and what Medicare and BCBS don't pay, they write off.

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