It’s sad to say, but many Americans have ongoing health problems. As reported by the CDC, 6 in 10 Americans have at least one chronic health condition. Additionally, 4 in 10 adults in America suffer from two or more ongoing health problems.
Today, we will discuss long-term chronic health conditions and how Medicare supports millions of Americans affected by these conditions.
Guide to Medicare coverage for chronic health condition management
Adults living with chronic health conditions deal with many struggles. Juggling doctor’s office visits, prescriptions, and much more can become taxing and exhausting. This is where management of your chronic condition helps tremendously!
Medicare enrollees with two or more chronic health diseases and at risk of a severe decline in health or even death may qualify for this type of healthcare management plan.
In conjunction with your physician, you’ll create a detailed plan for tackling your specific conditions to get you on the road to better health. Chronic care management health plans generally include the following:
- Patient’s medical history
- List of doctors
- Medications list
- Allergies
- Healthcare goals
- Patient updates
- And more
To qualify for a CCM plan, you must meet the following qualifications:
- Your doctor expects you to have at least 12 months left to live
- Must be at risk of severe health decline or death
- Must be diagnosed with at least two chronic health conditions
Furthermore, ensure your healthcare provider accepts Medicare to ensure you’ll have no issues with coverage.
What does Medicare consider a chronic health condition?
Medicare considers many different conditions to be chronic. Asthma, arthritis, mental illness, and autoimmune diseases are some chronic health conditions. Epilepsy, MS, and other neurological disorders also qualify as chronic conditions, according to Medicare.
Chronic health conditions information
Chronic health conditions are health conditions that last for at least one year and need continuous medical care or restricted activity. The most common forms of chronic conditions in the U.S. are diabetes, heart disease, and cancer.
How Medicare covers chronic health conditions
Medicare can cover chronic health issues that are both short-term and long-term. Both traditional Medicare and Medicare Advantage offer medically necessary treatments for chronic conditions.
Generally, Medicare will cover medically necessary therapies and medical supplies, but there are limitations and restrictions for coverage—for example, prior authorizations and cost-sharing. Be sure to check your Medicare coverage to understand better your benefits and all costs associated with your health condition.
Costs of Medicare chronic care management
Some of the most common costs associated with Medicare’s chronic care management are copays and deductibles. Depending on beneficiaries’ specific Medicare plans, Medicare beneficiaries could be responsible for copays and deductibles related to CCM services.
Additional costs could also be incurred, like the technology that offers remote monitoring with physicians and providers. And just as with all outpatient services, beneficiaries are responsible for a 20% coinsurance cost for services received in a CCM plan.
Original Medicare coverage for chronic care management
Traditional Medicare can include coverage for chronic care management. Part A will cover costs associated with skilled nursing facilities, hospitals, and nursing homes. And Part B will cover expenses related to doctors’ office visits, DME (durable medical equipment), and various outpatient healthcare services. Part B can step in to help with the management of treatments, care, and prescription medications for adults with chronic conditions.
Medicare Advantage coverage for chronic care management
Medicare Advantage plans will cover chronic care management if, of course, it’s deemed medically necessary. The patient must have at least two chronic health conditions to qualify for coverage through a Medicare Advantage plan. In addition to covering everything that traditional Medicare covers, Medicare Advantage plans can provide additional coverage benefits, like hearing, vision, and dental.
Medicare Supplement coverage for chronic care management
Medicare Supplement plans (Medigap) can also cover chronic care management plans. Not only costs covered that are associated with CCMs but also anything that Medicare doesn’t typically cover.
For instance, if you have any copays associated with your appointments regarding your CCM, your Medicare Supplement plan can step in to help cover these copays. Medigap policies vary in price and coverage, depending on your specific plan.
Medicare chronic care management
Medicare helps cover many chronic health conditions and will cover these conditions if you meet the necessary qualifications. Let’s look at some of the most common chronic conditions below.
Examples of chronic health conditions
- Cancer
- High blood pressure
- Diabetes
- Obesity
- Heart disease
- Arthritis
- And much more
Enrolling in Medicare chronic care management
To enroll in Medicare’s chronic care management, you must first enroll in Medicare Part B. If you have Part C coverage, you can enroll in a CCM. Remember, if you only have Part A coverage, you won’t be able to enroll in a chronic care management plan.
You’ll need to first visit with CCM healthcare providers approved through Medicare. This can include physician assistants, doctors, and nurse practitioners. From there, your provider will help to create a care management plan designed specifically for you.
FAQs
What health conditions are considered chronic?
Many health issues are considered to be chronic. The most prevalent diseases are cancer, diabetes, and arthritis.
Are there special plans for individuals with chronic health conditions?
Yes, special plans are created solely for individuals with chronic conditions. These are Medicare Advantage plans called chronic condition special needs plans (C-SNP).
What are the most common chronic health conditions?
The most common chronic health conditions are cancer, heart disease, and lung disease. Alzheimer’s, strokes, chronic kidney disease, and diabetes are some of the most common chronic conditions.
What chronic conditions will allow someone to qualify for Medicare before turning 65?
Individuals who are under 65 may still qualify for a CCM if they have qualifying chronic health conditions. To be eligible for this, these beneficiaries must have gotten Social Security Disability benefits for at least 24 months or have been diagnosed with the chronic conditions ALS or ESRD.
Enrolling in a Medicare plan to provide coverage for chronic health conditions
Not only do chronic conditions cause an immense amount of stress, but they can also cost an immense amount of money. Thankfully, health insurance options are available to help ease the costs associated with chronic health conditions. Call us or complete our rate form to obtain your free quote and see how enrolling in a Medicare plan can help provide tremendous coverage for your chronic health conditions.
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