Chronic care management and other monthly care services

Medicare pays some providers a monthly fee to manage your care between visits. Each service needs your agreement, and you pay a share of the monthly fee.

Chronic care management

If you have 2 or more serious conditions expected to last at least a year, like arthritis and diabetes, your provider can help manage them. You get:

• A care plan listing your health problems and goals, other providers, medicines, and community services you have and need.
• 24/7 access for urgent care needs.
• Support when you move between care settings, like going home from the hospital.
• A review of your medicines and how to take them.

Advanced Primary Care Management

Some primary care practices offer a monthly service that coordinates and tailors your care, with 24/7 access to your care team, full care management and help with transitions. You pay 20% of the Medicare-approved amount after the deductible. Ask your primary care provider whether they offer it.

Chronic pain management

For pain lasting more than 3 months, monthly services can include pain assessment, medicine management and care coordination.

Behavioral health integration

If you have depression, anxiety or another mental health condition, your provider may manage it as part of your regular care, for example through a collaborative care team with care planning, check-ins, medicine support and counseling. You sign an agreement to get it monthly. See mental health coverage.

What you pay

The Part B deductible and coinsurance apply to the monthly fees. Medigap, Medicaid or other supplemental coverage may pay your share. In a Medicare Advantage plan, your costs may differ.