Pressure to drop the 20% coinsurance on chronic care management will build through 2028 as the Part B deductible rises to $283 in 2026. Until Congress passes the bipartisan bill to eliminate it, Original Medicare patients will keep paying a share of each monthly service, while at least one Cigna member reports being offered CCM with no copay and no deductible.
Key Points
- The Centers for Medicare & Medicaid Services defines chronic care management as care for two or more chronic conditions expected to last at least 12 months, or until death.
- Medicare's 2026 figures put the Part B deductible at $283, after which Original Medicare patients pay 20% coinsurance for each monthly chronic care management service.
- A 2024 Journal of the American Geriatrics Society study found chronic care management use among older beneficiaries with two or more conditions rose from 1.1% in 2015 to 3.4% in 2019.
Three things families believe about chronic care. Myth or fact?
Call each one, then see how other readers called it.
1
Chronic care management is only for the very sickest patients. In 2019, 9.4% of severely frail beneficiaries with two or more conditions used it, against 1.9% of robust ones. Frailty was never the test. Section ›
2
For some complex conditions, Medicare leaves the care plan to your doctor. Medicare's guidance says it doesn't define those plans "due to diagnostic uncertainty," so your provider builds one. It can help to ask for a copy. Section ›
3
If the first call gets no answer, the benefit isn't there. One of our advocates needed some time on the phone with Medicaid before confirming a patient's transportation benefit. Patience on the line is often part of the job. Section ›
Short answer: What Is Chronic Care Under Medicare and Who Qualifies in 2026 is a Medicare care-navigation topic and refers to the practical steps explained in this guide. Learn what chronic care means under Medicare, who qualifies for chronic care management in 2026, what Part B charges, and how to ask your doctor about it. Understood Care advocates have helped thousands of members with what is chronic care. Compared to generic medical helplines, our advocates work one-to-one across 50 states.
Quick Answer
Under Medicare, chronic care usually refers to chronic care management, a monthly Part B service for people with two or more chronic conditions expected to last at least 12 months.
You enroll through a doctor's office that offers it. Your plan shapes the rest. Skilled Nursing News reported in September 2026 that under Medicare Advantage, nursing homes can face payment cuts or discharge pressure as early as day two of a patient's stay.
One candid aside: the evidence I have seen does not show how often Medicare Advantage members get this service. Asking your doctor's office directly is how you find out.
Did this answer your question?
Chronic care management often happens by phone between visits, built around a written care plan.
Two diagnoses can sit on a chart for years before anyone mentions chronic care. You are not alone if that sounds familiar. Diabetes, high blood pressure, COPD, depression, glaucoma and atrial fibrillation are common examples, and many people live with two of them without hearing that a monthly coordination service exists for people like them.
Diagnoses are only half of it. Whether that service reaches you also depends on your doctor's office and on your plan, whether that is Original Medicare or Medicare Advantage, the private plans that stand in for it.
Plans can shift under you, too. In September 2026, Skilled Nursing News reported that Saber Healthcare Group, a large nursing home operator, had ended five to seven Medicare Advantage contracts over the past 24 months, because, as its founder Bill Weisberg put it, the plans did not cover the cost of care. In the same report, Gary Blake, CEO of Creative Solutions in Healthcare, argued that perks like $25 grocery cards can overshadow the quality and adequacy of care. He added that a better plan, or Traditional Medicare, may suit people with frequent hospital visits.
Nursing home contracts may feel far from your own kitchen table. They sit closer than they look. For someone managing two or more lasting conditions, the plan you are in shapes which providers you can use and what your monthly share looks like.
On 2026 enrollment, our data shows UnitedHealthcare holds 26% of Mississippi's Medicare Advantage members, and Understood Care accepts its Medicare Advantage plans there alongside Original Medicare. Even so, we confirm your coverage before your first session.
If I were reading this for a parent, I would keep the plan question and the condition question side by side, starting with what Medicare actually means by chronic.
Maybe a letter from your doctor's office used the phrase chronic care management, or a nurse brought it up at the end of a visit, and you nodded without being sure what it meant. That's common. Under Medicare, chronic care means Chronic Care Management (CCM), a monthly Part B benefit. Your doctor's team coordinates your care between visits when you live with two or more conditions expected to last at least a year.
Medicare's own guidance calls CCM "a critical primary care service that contributes to better patient health and care." Behind it sits a written care plan that can draw on 12 possible components, from a problem list and measurable treatment goals to symptom management and a caregiver assessment. Before the monthly service starts, new patients and anyone the practice hasn't seen within the previous year need an initiating visit. That first visit can be a full office exam, an annual wellness visit, or the initial preventive physical exam (the first preventive checkup after you join Medicare). It is billed separately from CCM.
Here is the thing. Many people who qualify are never given a plain explanation, so they never ask. I'd put that on the language, not on you. These rules were written for billing offices, not for someone juggling diabetes, high blood pressure and a weekly pill organizer.
Once the benefit is laid out in everyday words, your own situation may look different, starting with what Medicare counts as chronic care in the first place.
Questions this article answers
- What is chronic care under Medicare? Plain words, no jargon.
- Who qualifies for chronic care management in 2026? The two-condition rule, and the cases that fit around it.
- How much does chronic care management cost with Medicare Part B in 2026? The deductible, the monthly share, and what to ask before you sign.
What does chronic care mean under Medicare?
Under Medicare, chronic care means Chronic Care Management (CCM), a monthly Part B service where your doctor's team coordinates care for two or more lasting conditions between visits.
It can help to check three things first:
- You live with two or more health conditions your doctor expects to last a year or longer.
- You see more than one doctor, or take several medicines, for those conditions.
- No office has ever asked you to sign an agreement for monthly care coordination.
If all three sound familiar, you are not alone. Many people who fit the first two have never heard their own doctor mention this benefit.
The Centers for Medicare & Medicaid Services (CMS) defines CCM as "managing a patient's multiple (2 or more) chronic conditions expected to last at least 12 months, or until their death," and calls it "a critical primary care service that contributes to better patient health and care." Translation: when your health needs steady attention rather than a one-time fix, Medicare has a benefit built for exactly that.
Here is what the monthly service includes:
- A comprehensive care plan listing your health problems and goals, your other providers, your medications, and the community services you have and need
- 24/7 access for urgent care needs
- Support when you move from one care setting to another, like coming home after a hospital stay
- A review of your medications and how you actually take them
Your provider will ask you to sign an agreement first. After that, the office prepares a care plan for you or your caregiver that explains the care you need and how your providers will coordinate it.
The common assumption is that chronic care means a nursing home or round-the-clock help at home. Under the CCM benefit, it means something quieter. A written plan. A team you can reach. A regular look at your medicines between visits.
That quieter help filled a real hole. In a 2020 paper, William R. Mills, MD, and colleagues noted that Medicare fee-for-service historically had no "in-between visit" care management benefit, even though people with several conditions often run into problems between appointments. The same paper summarized a CMS-commissioned evaluation by Mathematica Policy Research, where CCM patients were hospitalized less and used the emergency department less. The paper reported in 2020 that, after setting aside patients who received only one month of CCM, those CCM patients had cost Medicare $95 less per month.
For you, that may mean fewer unplanned hospital trips. It also means CCM is a tested Medicare service, not an extra to shrug off.
One rule shapes how CCM works day to day. Only one practitioner can provide and be paid for CCM in a calendar month, and you can stop at any time, with the change taking effect at the end of that month. The rule is not just paperwork. A 2021 federal audit of 2017 and 2018 claims found 38,447 claims where providers billed CCM more than once for the same person in the same period.
In practice, it helps to know which office is your CCM home. If two offices both bring it up, ask which one holds your care plan.
A review of 5 sources suggests one steady pattern: Medicare's chronic care rules are specific and the help is real, yet someone still has to connect the patient to it. That connecting work is where an advocate fits. Understood Care accepts Original Medicare in Mississippi, along with Medicare Advantage plans from UnitedHealthcare, and our review of 2026 enrollment shows about 65% of Mississippi's Medicare Advantage members are with an insurer we accept. We confirm your coverage before your first session. If blood pressure is one of your conditions, our guide on how a patient advocate helps seniors with high blood pressure shows what that teamwork can look like.
The harder question is whether your own mix of conditions counts, and that rule has more room in it than many families expect.
Who qualifies for chronic care management in 2026, and do you need two conditions?
Most people qualify with two or more chronic conditions expected to last a year or longer, though Medicare also covers some complex, hard-to-diagnose cases.
The CMS chronic care page, last modified January 20, 2026, sets out the full rule. You qualify when you have:
- Two or more chronic conditions
- That are expected to last at least 12 months, or until the end of life
- That place you at significant risk of death, acute exacerbation or decompensation, or functional decline
Those last words are heavy, so here they are in plain language. An acute exacerbation is a sudden flare-up. Decompensation means a condition that was under control stops being controlled. Functional decline means losing the ability to handle everyday tasks, like dressing or cooking.
Medicare names many qualifying conditions, including diabetes, hypertension (high blood pressure), COPD, atrial fibrillation, depression, glaucoma, osteoarthritis, cancer, and Alzheimer's disease and related dementia. Its lists are framed as "including, but not limited to." That phrase matters. Your conditions do not need to appear on a list; they need to meet the time and risk test.
There is also an edge many people miss. Medicare covers CCM for some patients whose complex conditions require moderate or high complexity medical decision making, meaning the doctor has to weigh many moving parts at once. That includes infection-associated chronic conditions and illnesses (IACCI), such as Lyme disease and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It also reaches conditions with ambiguous diagnoses or limited biomarkers, which are the lab tests that usually confirm a diagnosis.
If you were told years ago that you did not qualify, it may be worth asking again. Rules at the edges do shift.
Doctors also look past the bare count. In a 2025 analysis, Avalere Health noted that practitioners are encouraged to weigh how many medications a patient takes, repeat hospital admissions, and past emergency department visits. Avalere also found that in 2023, only 77% of billed CCM services listed two or more chronic conditions on the claim, while 18% listed one and 5% listed none.
Avalere read that gap as a question about coding accuracy. For you, the lesson is simple. Ask that every long-term condition you live with be written clearly in your chart.
Lists of qualifying conditions vary with who writes them. A 2025 guide from a company that sells CCM software claimed more than 60 conditions count, adding heart failure, anxiety, chronic kidney disease, and cancer in active treatment or surveillance. I'd treat any long list, that one included, as a set of examples. The time and risk test is what decides.
A newer program opens a different doorway. The ACCESS model, a 10-year voluntary payment program from the CMS Innovation Center that started July 1, 2026, is built around four condition tracks:
- Early cardio-kidney-metabolic: hypertension, prediabetes, obesity
- Cardio-kidney-metabolic: diabetes, chronic kidney disease, heart disease
- Musculoskeletal: chronic musculoskeletal pain
- Behavioral health: depression and anxiety
Joining is voluntary, and patients keep their regular Medicare benefits. Whether a practice near you takes part is a fair question to ask. If heart disease is one of your conditions, our guide to heart care support for seniors on Medicare walks through where an advocate can step in.
Qualifying on paper is one thing. Getting an office to start the service, and knowing what you will pay each month, comes next.
How do you get chronic care management in 2026, and what will it cost?
Ask your main doctor's office to start it. In 2026, Original Medicare patients pay the $283 Part B deductible first, then 20% coinsurance; Medicare Advantage plans set their own share.
Money talk can feel uncomfortable, especially when you're already juggling appointments. You are not alone in wanting the numbers first. Medicare's 2026 figures put the Part B deductible at $283 a year, up from $257 in 2025, and the standard Part B premium at $202.90 a month. Because chronic care management is a Part B service billed once a month, the first months of a year may count toward that deductible before your 20% share begins.
How much is 20%? Fierce Healthcare reported in April 2026 that backers of a bipartisan bill put the coinsurance at "often around $12 a month." Small, yes. Lawmakers and supporters said a separate monthly bill, with no appointment tied to it, can confuse seniors and make it harder for offices to get the consent the service requires. The Chronic Care Management Improvement Act, from Reps. Suzan DelBene and Mike Kelly, would remove that coinsurance, and 40 health care and patient groups signed a letter backing it. Unless it becomes law, the 20% share stays.
The same coverage shows how few people get through the door. A 2022 report on 2019 traditional Medicare claims found only 882,000 people, or 4%, of the more than 22 million who were eligible had received chronic care management. A charge you don't understand is an easy one to refuse. Cost is one reason. Never being offered the service may be another.
Medicare Advantage works differently. Your plan decides what you owe, and some insurers now reach out to members who meet the two-condition test. One member's 2026 account of an insurer's offer described at least 20 minutes a month of care outside office visits, with no copay or deductible. Get a promise like that in writing. If you'd like support making those calls, this guide to patient advocate services for Medicare Advantage plans walks through who can help.
Which path you're on is close to a coin toss in some states. Our 2026 enrollment figures show about 47% of Mississippi's Medicare beneficiaries are in Medicare Advantage, and about 52% in Nevada, with the rest in Original Medicare. In Nevada, Understood Care accepts Original Medicare and Medicare Advantage plans from UnitedHealthcare, and about 68% of the state's Medicare Advantage members are with an insurer we accept. So check the card in your wallet before you compare any numbers.
My view: settle the money questions before you sign anything. These four steps can help.
- Ask the doctor who knows your conditions best whether their office offers chronic care management.
- Confirm whether you have Original Medicare or a Medicare Advantage plan.
- Ask what your monthly share will be, and whether early-year months fall under your deductible.
- Give your consent once those answers make sense to you, not before.
That fourth step is where lawmakers say people get tangled, and it goes more smoothly with someone on the line beside you.
Our predictions for 12-24 months
Where Medicare chronic care coverage heads next
Forecasts on who qualifies for Medicare chronic care management, what it costs patients, and how CMS pays for it through 2028.
A
What changes for chronic care patients by 2028
Read each forecast with its confidence level and early warning sign before choosing a chronic care program, practice or Medicare plan.
Despite an 8-11% increase in 2026 payments for CCM codes and the launch of new payment models, chronic care management is likely to reach only a small minority of eligible beneficiaries through 2028, because the barriers documented since the 2015 billing code, patient coinsurance and practice staffing, sit outside the fee level.
Through 2028, a growing share of Medicare chronic care management will be delivered by phone through remote clinical staff working on behalf of physicians, since CMS pays for non-face-to-face time and one estimate put a single full-time nurse at about 500 CCM patients a month.
Through 2028, Medicare's core test for chronic care management will stay at two or more chronic conditions expected to last at least 12 months, while CMS keeps widening the edges, as it did with longer staff time in 2017, physician time in 2019 and complex conditions such as infection-associated chronic conditions and illnesses (IACCI).
Expect continued federal scrutiny of duplicate and overlapping chronic care management claims through 2028, pushing practices to enforce more strictly the rule that only one clinician bills CCM for a patient each month and to document patient consent before services start.
As the CMS Innovation Center's 10-year ACCESS model admits its first participant cohorts from July 2026, more Medicare beneficiaries with hypertension, diabetes, chronic kidney disease, chronic musculoskeletal pain, depression or anxiety will be offered technology-enabled programs whose full payment depends on hitting measured targets such as a 10 mmHg drop in blood pressure.
Not Fully Confirmed Yet CMS guidance last modified 01/20/2026 extends CCM to some patients with complex conditions requiring moderate or high complexity medical decision making, including IACCI. Backers of the bipartisan bill put the CCM coinsurance at often around $12 a month, and the 2026 Part B deductible climbed to $283 from $257 in 2025. ACCESS started July 1, 2026 as a voluntary program with four condition tracks, with new participant cohorts admitted in waves through the early 2030s. An OIG audit reviewing $356 million in CCM claims from 2017 and 2018, including more than 7.8 million physician claims, reported that Medicare continues to make overpayments for chronic care management, including through duplicate billing. Only 882,000 (4%) of more than 22 million eligible traditional Medicare patients received CCM in 2019 claims, and a separate report put enrollment at 1.8% of beneficiaries with multiple chronic conditions, even though about two thirds of the fee-for-service population have two or more chronic conditions. CMS now pays for CCM under six CPT codes, 99437, 99439, 99487, 99489, 99490 and 99491, with 99437 added in 2022.
B
Sources behind the chronic care forecasts
Each public source below is listed with the specific line on Medicare chronic care rules, costs or uptake that a forecast rests on.
| Source | What it states | Forecasts it backs |
|---|---|---|
| Bipartisan bill would ax chronic care management cost sharing [Web source] | The bill would eliminate the 20% coinsurance that Medicare beneficiaries must agree to before receiving chronic care management (CCM) services. Backers say the cost is "often around $12 a month.". “Removing barriers to chronic care management is key to lowering healthcare costs and delivering better results for seniors.” Only 882,000 (4%) of eligible patients have received CCM services. This figure comes from a 2022 report reviewing 2019 traditional Medicare claims, described as "the most recent data available.". |
Patient cost sharing becomes the main fight Higher pay will not fix low chronic care uptake |
| Chronic care management services - Medicare [Government] | Cost: after the Part B deductible is met, the beneficiary pays 20% of the Medicare-approved amount (coinsurance). “You must have 2 or more serious chronic conditions (like arthritis and diabetes) that you expect to last at least a year” | Patient cost sharing becomes the main fight |
| Medicare 2026 amounts (CMS): Part B premium $202.90 a month, Part B deductible $283, Part [Government] | For 2026 the standard monthly Medicare Part B premium is $202.90, up from $185.00 in 2025, and the annual Part B deductible is $283, up from $257 in 2025. | Patient cost sharing becomes the main fight |
| Chronic Care Management (CCM) [Community / Forum] | Per the insurer's description as relayed by the OP, the patient pays nothing out of pocket for CCM, with no copay and no deductible. “at least 20 minutes of non-face-to-face care per month, including care coordination, phone calls, and medication management and a written or electronic…” Per the OP's reading of the materials, "only one doctor can bill" for CCM. |
Patient cost sharing becomes the main fight Billing scrutiny tightens on chronic care claims |
| Chronic Care Management Statistics and Facts (2026) [Web source] | The Journal of the American Board of Family Medicine reported that only 1.8% of Medicare beneficiaries with multiple chronic conditions were enrolled in CCM programs. | Higher pay will not fix low chronic care uptake |
| A Platform and Clinical Model to Enable Medicare's Chronic Care [Academic] | About two thirds of the Medicare fee-for-service population have ≥2 chronic conditions. “The results were striking, especially because CCM participating practices used many different approaches to operationalizing the program.” | Higher pay will not fix low chronic care uptake |
| Nurses working from home over the phone [Community / Forum] | The poster estimated one full-time nurse could handle about 500 CCM patients per month and pitched the role as paying $90K/year working from home. “The Medicare Chronic Care Management program allows physicians to bill for non-face-to-face patient care in between office visits.” | Remote nurse teams carry more chronic care work |
| Chronic care management in Medicare: Optimizing utilization [Web source] | CMS pays for CCM under six CPT codes: 99437, 99439, 99487, 99489, 99490 and 99491. Code 99437 was new in 2022. “To qualify for CCM, patients must have at least two chronic conditions expected to either persist for at least 12 months or pose a significant risk of death,…” | Remote nurse teams carry more chronic care work |
| Use of Chronic Care Management Service among Medicare - PMC [Academic] | CMS introduced Chronic Care Management (CCM) services on January 1, 2015, to pay for non-face-to-face clinical staff time each month spent on care coordination and continuity of care for patients with multiple chronic diseases. “The Centers for Medicare and Medicaid Services (CMS) introduced Chronic Care Management (CCM) services in 2015 for patients with multiple chronic diseases.” Expansions: on January 1, 2017, CMS expanded coverage to pay for longer non-face-to-face clinical staff time. In January 2019, CMS further expanded coverage to include non-face-to-face time by physicians or other qualified healthcare… |
Remote nurse teams carry more chronic care work Two-condition rule holds while its edges widen |
| Chronic Care Management for Complex Conditions - CMS [Government] | CCM also covers some patients with complex conditions requiring moderate or high complexity medical decision making, including infection-associated chronic conditions and illnesses (IACCI). “Medicare covers chronic care management (CCM), which is managing a patient’s multiple (2 or more) chronic conditions expected to last at least 12 months, or…” | Two-condition rule holds while its edges widen |
| Medicare Continues To Make Overpayments for Chronic Care - OIG [Government] | The audit covered CYs 2017 and 2018: more than 7.8 million physician claims and more than 240,000 hospital claims for noncomplex and complex CCM, totaling $356 million in paid claims. “CCM services are a relatively new category of Medicare-covered services and are at higher risk for overpayments.” | Billing scrutiny tightens on chronic care claims |
| CMS ACCESS Model: Tech-Enabled Chronic Care with Outcome [Substack / Newsletter] | ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) was launched by the CMS Innovation Center in late 2025. It is a 10-year voluntary payment program starting July 1, 2026. “ACCESS is CMS's most aggressive test yet of value-based specialty care in the outpatient setting.” | Outcome-based payment arrives for chronic care |
| The New ACCESS Model from the Centers for Medicare and [Substack / Newsletter] | ACCESS introduces Outcome-Aligned Payments (OAPs). Participating care organizations receive recurring payments for managing patients' qualifying conditions, and full payment depends on achieving measurable health outcomes tailored to each… “More than two-thirds of Medicare beneficiaries live with chronic conditions like hypertension, diabetes, chronic pain, or depression.” | Outcome-based payment arrives for chronic care |
C
What would shift the chronic care outlook
These forecasts assume current trends continue. The scenarios below would meaningfully change them.
One Thing to Keep in Mind
Weigh these differently: “Patient cost sharing becomes the main fight” has the strongest case behind it, “Higher pay will not fix low chronic care uptake” is the one worth watching closest for a reversal.
- Should the trend change course, the call “Patient cost sharing becomes the main fight” gives way first.
- Stronger contrary evidence in the sources would make the call “Higher pay will not fix low chronic care uptake” the sturdier one.
Methodology
Each forecast is scored 0-100 from the public sources shown for it: how many there are and how authoritative they are.
What will matter most for chronic care under Medicare in the next 12 to 24 months?
Expect the two-condition rule to stay put while its edges keep widening, billing checks to tighten, and the hardest problem to remain the same: getting eligible people to say yes.
Rules like these rarely change overnight, and that can be a comfort. Here is how I read the next two years, with the signal behind each call and what it may mean for you.
| Prediction | Weak signal | Why it matters to you | Source |
|---|---|---|---|
| The two-condition rule holds while its edges widen. | Medicare's January 2026 guidance already extends chronic care management to some complex conditions that call for moderate or high complexity decision making. | If you were once told a single hard-to-diagnose illness doesn't count, it may be worth asking again. | Medicare chronic care guidance for complex conditions, January 2026 |
| Billing checks keep tightening, so one practice coordinates your care. | A 2021 federal audit of 2017 and 2018 claims, covering $356 million in paid claims, found $1.9 million in overpayments on 50,192 claims, with patients' cost sharing on those claims reaching up to $540,680. | If you see several specialists, you may be asked to pick one practice. Signing up with two at once can leave you sorting out charges later. | Federal audit of chronic care management claims, 2021 |
| Uptake stays lowest among people with fewer conditions. | In 2019, 2.1% of beneficiaries with two to five conditions used the service, against 7.0% of those with ten or more. | With two or three conditions, nobody may raise it with you, so the asking often falls to you or your family. | 2024 study of Medicare claims from 2015 to 2019 |
Notice what the three rows share. Each one puts more weight on the conversation between you and your doctor's office, not less.
Three developments could change this picture. If Congress passes the bipartisan bill to drop the 20% coinsurance, one hurdle at the moment of consent disappears. If the voluntary ACCESS model grows, more chronic care may be paid for results rather than minutes on the phone. And if new audits turn up fresh problems, Medicare could tighten who qualifies instead of widening it.
I hold these predictions loosely. The national uptake counts most people quote reach back to 2019 claims, so the real picture in 2026 may be better or worse than those numbers show.
Whichever way it breaks, your first move stays the same: bring up chronic care management by name at your next visit, and ask what the first months of the year will cost.
Medicare's rule for chronic care management asks for two conditions expected to last 12 months, a bar many people on Medicare already clear without knowing it. Yet in the most recent claims anyone has counted, only a small slice of the people who qualified ever received the service. I don't expect new billing codes or payment models to close that gap on their own. It closes when someone explains the benefit in plain words and then helps you ask.
That kind of help often looks ordinary. In June 2026, one of our Florida advocates called Medicaid for a patient and, although it took some time, confirmed she qualified for free transportation. No headline, just a phone call that stayed open until there was an answer.
Rides, refills, care plans. Each one starts with a call someone has to make.
If you live with two or more lasting conditions, it can help to ask your main doctor's office whether it offers chronic care management and to bring a list of your medications. Bring that confusing letter along too, if you still have it. Call 646-904-4027 to talk with an advocate.
Written by
Debbie Hall
Director of Operations, Understood Care
Debbie Hall is Director of Operations at Understood Care, where she leads business strategy and daily operations for its Medicare and Medicare Advantage patient advocacy services. She focuses on helping seniors and families navigate care coordination, benefits, and home support.
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Frequently asked questions about chronic care under Medicare
Medicare treats chronic care management as an opt-in monthly Part B service for two or more lasting conditions, and you can leave it whenever you choose.
How many people on Medicare actually use chronic care management?
Very few. A 2024 study in the Journal of the American Geriatrics Society found that use among fee-for-service beneficiaries 65 and older with two or more chronic conditions rose from 1.1% in 2015 to 3.4% in 2019. The authors described a service used by "a very small fraction of eligible patients," and nearly one in five people who tried it did not continue after the first service.
Do most people on Medicare have two or more chronic conditions?
Many do. A 2020 estimate put about two thirds of the Medicare fee-for-service population (people in Original Medicare) at two or more chronic conditions. So the rule is narrow on paper and wide in real life.
Can you stop chronic care management after you sign up?
Yes. You can stop at any time, and the change takes effect at the end of that calendar month. Your practice notes your consent, or your refusal, in your medical record. If you're unsure, I think a few months is a fair trial.
What does chronic care management include?
Your provider prepares a care plan, a written list of your health problems, goals, medications, other providers and community services. You also get round-the-clock access for urgent needs, support when you move from one care setting to another, and a review of how you take your medications. A copy of the plan goes to you or your caregiver.
Does Understood Care work with Medicare?
Yes. Our advocacy is available in all 50 states, delivered virtually and covered by Medicare. We support people across the United States with Traditional Medicare and Humana Medicare Advantage, and we confirm your coverage before your first session. Call 646-904-4027 to talk with an advocate, or visit understoodcare.com/advocates.
How we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat: state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
Editorial review: Every published sentence was written and reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: What Is Chronic Care Under Medicare and Who Qualifies in 2026, reviewed by the Understood Care Editorial Team.