Medicare Chronic Care Management: Coverage, Costs, and Who Qualifies in 2026
Medicare Part B covers chronic care management (CCM) — at least 20 minutes a month of non-face-to-face care coordination for people with two or more serious chronic conditions expected to last at least a year. After you meet the 2026 Part B deductible of $283, you generally pay 20% coinsurance on the Medicare-approved amount.
What chronic care management covers
Chronic care management (CCM) is a distinct Medicare benefit, not a single office visit. Under Part B, Medicare pays a doctor, nurse practitioner, or other qualified health professional to coordinate your care between appointments when you live with multiple serious chronic conditions. The work happens largely outside the exam room — phone check-ins, prescription coordination, and updates to a written care plan.
CMS describes the core of the benefit as at least 20 minutes per calendar month of non-face-to-face clinical staff time, directed by a physician or qualified health professional, spent coordinating your care. Practices that spend more time may bill for additional time or for 'complex' CCM, which involves more intensive coordination.
- A comprehensive, written care plan you receive a copy of
- 24/7 access to a professional for urgent care needs
- Coordination among your pharmacy, specialists, testing centers, and hospitals
- Medication management and review
- Help with transitions between care settings, such as after a hospital stay
- A secure electronic way to communicate with your care team
Who qualifies for CCM
To be eligible, Medicare requires that you have two or more serious chronic conditions that are expected to last at least 12 months (or until the end of life). Common examples include diabetes, arthritis, heart disease, high blood pressure, depression, COPD, and Alzheimer's disease.
The conditions must also place you at significant risk of death, acute worsening or decompensation, or functional decline. That risk threshold is why CCM is aimed at people managing genuinely serious, ongoing illness rather than a single minor condition.
Your provider must get your consent before starting CCM and must tell you that cost-sharing may apply. Only one practitioner can bill Medicare for CCM for you in a given month, so coordination usually runs through your primary care provider. You can stop the service at any time.
What you pay in 2026
CCM is covered under Part B, so the standard Part B cost-sharing applies. In 2026 the Part B deductible is $283 per year. After you meet it, you generally pay 20% coinsurance on the Medicare-approved amount for the service, and Medicare pays the other 80%.
Because CCM is billed monthly, the coinsurance is a recurring charge for as long as you receive the service. The exact dollar amount depends on the Medicare-approved fee for the specific CCM code your provider bills and on whether standard or complex CCM is used, so ask your provider's office for their estimate before enrolling.
The 2026 standard Part B premium is $202.90 per month, which you pay whether or not you use CCM. If your modified adjusted gross income from 2024 was above $109,000 (single) or $218,000 (joint), an income-related adjustment (IRMAA) can raise the total Part B amount to between $284.10 and $689.90 per month.
- Part B deductible (2026): $283 per year
- Coinsurance after the deductible: 20% of the Medicare-approved amount
- Part B premium (2026): $202.90 per month (higher with IRMAA)
Ways the coinsurance may be covered
The 20% coinsurance is not necessarily money out of your own pocket. How it is handled depends on the rest of your coverage.
A Medigap (Medicare Supplement) policy is designed to help pay Part B coinsurance and copayments, so many Medigap enrollees pay little or nothing extra for CCM beyond their premium. If you have full Medicaid or qualify for a Medicare Savings Program, that coverage may pay the Part B cost-sharing as well.
If you are enrolled in a Medicare Advantage (Part C) plan rather than Original Medicare, your plan must cover at least what Original Medicare covers, but your specific cost-sharing, network rules, and any care-coordination programs vary by plan. Check your plan's documents or call the number on your member card — do not assume the Original Medicare figures above apply.
CCM vs. principal care management
Medicare also covers principal care management (PCM), a related but separate benefit. The key difference is the number of conditions: CCM is for people with two or more serious chronic conditions, while PCM focuses on managing a single complex chronic condition that is expected to last at least three months.
Both are billed under Part B and carry the same general cost structure — the Part B deductible followed by 20% coinsurance. If you have only one qualifying condition, ask your provider whether PCM is the more appropriate service.
Neither benefit replaces your regular office visits. CCM and PCM pay for the coordination work that happens between visits, on top of the in-person care you already receive.
Frequently asked questions
Is chronic care management the same as a regular doctor visit?
No. CCM pays for care coordination that happens outside of in-person visits — at least 20 minutes a month of non-face-to-face work like phone check-ins, medication review, and updating your care plan. It is billed in addition to, not instead of, your normal office visits.
Do I have to pay anything for CCM?
Possibly. CCM falls under Part B, so after the 2026 Part B deductible of $283 you generally owe 20% coinsurance on the Medicare-approved amount. A Medigap policy, Medicaid, or a Medicare Savings Program may cover that coinsurance. Medicare Advantage cost-sharing varies by plan.
How many chronic conditions do I need to qualify?
Medicare requires two or more serious chronic conditions expected to last at least 12 months (or until end of life) that put you at significant risk of death, acute worsening, or functional decline. If you have only one complex condition, principal care management may apply instead.
Can more than one doctor bill Medicare for my CCM?
No. Only one practitioner can bill Medicare for chronic care management for you in a given calendar month. This is usually your primary care provider, who coordinates with your other doctors.
Do I have to agree before CCM starts?
Yes. Your provider must obtain your consent before beginning CCM and must inform you that cost-sharing may apply. You can decline at the start or stop the service at any time.
Does Medicare Advantage cover chronic care management?
Medicare Advantage plans must cover at least what Original Medicare covers, so CCM is included, but your specific costs, networks, and any added care-coordination programs vary by plan. Check your plan documents or call the number on your member card for details.
Sources
Related guides
Medicare Login Guide is an independent resource and is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, or any government agency. This article is for general information only — confirm current figures and your specific options at medicare.gov or by calling 1-800-MEDICARE.