Chronic Care Management

Medicare-Covered Support for Multiple Chronic Conditions

Chronic Care Management (CCM) is a Medicare-covered Part B benefit designed for patients managing two or more long-term health conditions. If you're juggling diabetes, heart disease, arthritis, high blood pressure, COPD, or other ongoing conditions, CCM provides comprehensive care coordination, regular monitoring, and ongoing support between your doctor visits—helping you stay healthier at home while reducing emergency room visits and hospitalizations.

What's Included in Your CCM Program?

Our experienced care team provides personalized support that includes a comprehensive care plan addressing all your chronic conditions, medications, and health goals. You'll receive regular check-ins from your dedicated care coordinator to monitor your symptoms, review medication adherence, address new health concerns, and coordinate upcoming appointments.

We handle medication management including comprehensive reviews to identify potential interactions, refill coordination with your pharmacy, reminders to help you stay on track, and side effect monitoring. Our team also coordinates all your medical appointments-scheduling with doctors and specialists, providing reminders, coordinating labs and tests, and helping arrange transportation when needed.

You'll have 24/7 access to your care team for urgent questions or health concerns between regular check-ins. We also keep your designated family members informed with regular updates about your health status, upcoming appointments, and care plan progress (with your permission, of course).

Who Qualifies for Chronic Care Management?

You may be eligible if you have Medicare Part B or Medicare Advantage and two or more chronic conditions expected to last at least 12 months. Common qualifying conditions include high blood pressure, diabetes, heart disease, COPD, arthritis, high cholesterol, chronic kidney disease, depression, anxiety, osteoporosis, and memory loss. The list of chronic conditions is extensive and most patients 65 years or older have at least two qualifying conditions.

What Does It Cost?

Most patients pay little to no out-of-pocket cost. CCM is a Medicare Part B covered benefit. After your annual deductible, Medicare pays 80% and you're responsible for 20% coinsurance. If you have a Medigap plan, your supplemental insurance typically covers the 20% coinsurance resulting in $0 out-of-pocket. With Medicare Advantage, many plans cover the coinsurance for minimal to no cost.

Benefits You'll Experience

CCM helps you better manage your chronic conditions with improved medication adherence, earlier detection of health problems, fewer emergency room visits, and reduced hospital admissions. You'll maintain independence living at home with professional support for daily health challenges, less stress about managing multiple conditions, and peace of mind with 24/7 care team access. Your family benefits from regular updates, reduced caregiver burden, professional oversight, and early notification of potential problems.

You keep all your current doctors and specialists - we work alongside your existing medical team to support you between visits. You can discontinue services at any time with no penalty. This isn't short-term home health; it's ongoing preventive support to keep you healthy long-term.