If you’re managing multiple medications and conditions, you know it can be hard to juggle everything related to your healthcare needs. There can be confusion about medications prescribed by different medical specialists, medical tests can be unintentionally repeated and you might receive conflicting medical advice, necessitating a second (or third) opinion.
You’re also not alone; multiple chronic conditions are a prevalent issue in the U.S. A 2019 study published in BMC Geriatrics, for instance, suggests chronic diseases are common among adults over age 65, with 85% having one chronic condition and 60% having at least two.
Medicare beneficiaries who have more than one chronic condition, however, have access to the chronic care management (CCM) program, designed to help coordinate and streamline your medical care.
“Someone with a qualifying chronic condition — such as heart disease, arthritis, diabetes or chronic obstructive pulmonary disease (COPD) — should consider the CCM program. They can receive more specialized care for their chronic illnesses and will benefit from a care management team to help navigate their needs,” says Erin Nevins, president of EP Nevins Insurance Agency in Greenville, New York.
What Is Chronic Care Management?
CCM services prioritize ongoing care coordination and support for qualifying beneficiaries, with the following goals:
— Improve health outcomes: CCM provides structured care management for better long-term health outcomes
— Reduce hospitalizations: This program can help lower the rate of emergency room visits and hospital readmissions through medical interventions
— Boost quality of life: CCM prioritizes continuous care coordination that can improve daily health routines
— Support patients: CCM provides ongoing guidance to help patients manage their health needs
“What happens when people get more complex medically is it becomes harder to fit everything in the course of a 15- or 20-minute doctor visit. Oftentimes there needs to be care and follow-up that’s given between visits, and that’s really where chronic care management fits nicely. It allows for that connection and support between visits,” says Dr. Jay Lee, medical director at Integrated Health Partners of Southern California in San Diego and a board member of the American Academy of Family Physicians.
Because not all doctors who participate in Medicare also participate in CCM, it’s important to check with your doctor first.
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How Does Chronic Care Management Work?
In order to qualify for the CCM program, you’ll need to meet the following requirements:
— Medicare Part B enrollment: You must have active Medicare Part B coverage
— Qualifying health conditions: You must have two or more chronic conditions that last at least 12 months or up until death, risk of death, worsening of the disease or loss of function
— Written consent: Once you have determined that your provider participates in the program, you will need to provide written consent for your provider to bill the CCM program.
After you’ve qualified for the program, you’ll then work with your doctor to develop a customized care plan that focuses on your goals, medications and treatments. Be prepared with a list of all your providers, current prescriptions and any other pertinent information. The more details you can give your provider, the better they can help you.
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Key Benefits of the CCM Program
The CCM program offers numerous benefits for seniors, particularly those who struggle to manage their medical needs. Benefits of the program include:
— Better care coordination: Your doctors, specialists and other healthcare providers work together to manage your conditions. This approach reduces gaps in care and avoids duplicate tests or conflicting treatments.
— 24/7 access to healthcare support: You can contact a healthcare provider 24/7 to ask questions or address urgent concerns.
— Medication management: Your provider will coordinate your care with pharmacies, refilling prescriptions and preventing harmful drug interactions and unnecessary prescriptions.
— Monthly check-ins and ongoing support: A dedicated care team checks in regularly (by phone, online or in person) to monitor your health. These check-ins encourage early detection of issues before they become serious.
— Reduces hospital visits and complications. Knowing you have care support around the clock can help reduce unnecessary hospital visits. Patients can reach out to their care team before a condition worsens, instead of waiting until they need an ER visit.
“The healthcare system is very fragmented and can be difficult to navigate. It helps to have someone in your corner, which is what the CCM provides. Having this reduces the barriers and challenges that patients may have to (health) care,” Lee says.
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Cost of CCM
For beneficiaries, the costs associated with CCM will vary depending on Medicare coverage.
Generally, Part B covers CCM services, which means beneficiaries are responsible for their deductibles and coinsurance. Supplemental insurance, such as Medigap or Medicaid, may help cover the monthly costs.
You can also participate in the CCM program if you have a Medicare Advantage plan, but benefits depend on your specific plan’s coverage. Most Medicare Advantage plans offer similar chronic care management services, but they may have different rules, costs and providers than original Medicare, so it’s important to check with your plan.
| Coverage Type | 2026 Deductible Requirement | What You Pay |
| Original Medicare | Part B annual deductible ($283 in 2026) applies | 20% coinsurance of the Medicare-approved amount |
| Medigap | Depends on the policy design | 20% Part B coinsurance in full |
| Medicaid | $0 (typically covered by state Medicaid) | $0 (for dual-eligible beneficiaries) |
| Medicare Advantage | Depends on the specific plan | Fixed copayments or coinsurance up to yearly plan out-of-pocket limits |
“By having better management of chronic conditions, the CCM program may reduce overall healthcare costs for patients by reducing doctor visits, unnecessary medication charges and hospital stays, as well as other expensive healthcare-related expenditures,” Nevin says.
To get further information about your potential out-of-pocket expenses for CCM services, consult with your healthcare provider or contact Medicare directly.
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What You Need to Know About Medicare’s Chronic Care Management Program originally appeared on usnews.com
Update 08/13/26: This story was previously published at an earlier date and has been updated with new information.
