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Chronic Illness and Medicare—What You Need to Know

With a chronic illness, taking care of yourself is your top priority. But sometimes, it can feel hard to get the care you need.

More than 60% of people with Medicare live with a chronic condition, according to the U.S. Centers for Disease Control. Medicare is working to grow its chronic care management services. Ready to take a new look at your care options? Here’s what you need to know.

Have diabetes?

You may pay no more than $35 a month for your insulin under the Part D Senior Savings Model. These savings may be available if you have a Part D plan or a Medicare Advantage plan. Read the plan’s fine print. Some plans may not offer these savings or cover all insulin types.

Have chronic pain?

Original Medicare covers manipulation of the spine by a chiropractor to correct a subluxation (when spinal joints fail to move properly, but the contact between the joints remains intact). Medicare also covers a set number of visits for acupuncture within 90 days for chronic low back pain when meeting Medicare’s criteria. For most pain management services, you pay 20% of the Medicare-Approved Amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible also applies.

Medicare Advantage plans may offer additional acupuncture and/or chiropractic treatments.

Need help with extra services?

You might need more help at home with a chronic condition.

Many Medicare Advantage plans cover additional services like companion care, health-related transportation, or a quarterly over-the-counter (OTC) benefit allowance, according to the National Council on Aging opens a new window . Some plans include allowances for groceries, help paying for utilities, and support fitness memberships and other social activities. Check the plan’s details. All plans differ and some plans may limit the number of visits they cover.

Have a specific condition?

Look into a Medicare Special Needs Plan (SNP). It’s a type of Medicare Advantage plan that provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid coverage. SNPs tailor their benefits, provider choices, and list of drugs (formularies) to best meet the specific needs of the groups they serve. Your costs may also be lower.

You must live in the plan’s service area and have Medicare Parts A and B to qualify, and:

  • Have a severe or disabling chronic conditions (like diabetes, heart failure, End-Stage Renal Disease (ESRD), HIV/AIDS, dementia, and certain neurological disorders); or
  • Live in certain institutions (like nursing homes), or who live in the community but need nursing care at home; or
  • Eligible for both Medicare and Medicaid

Have two or more serious chronic conditions?

You can join Medicare’s Chronic Care Management services, or CCM. Through this program, your doctor—or a nurse practitioner or physician assistant—puts together a care plan that includes:

  • Your health problems and goals
  • Your providers
  • Your medications
  • Care you need
  • Community services you need
  • How care will be coordinated

Your provider is in charge of putting your care plan into action. They’ll help with medication management, provide 24/7 access for urgent care, coordinate care, and more. One big plus is that many of these services can happen outside of an office visit, including over the phone.

Have more questions?

You have another partner you can turn to—our licensed insurance agents. They’ll help you find the answers you’re looking for. Making it easier than ever to get the health care you need for your chronic condition.

Give us a Call

1-844-672-0317 (TTY: 711)
9 AM to 6 PM ET

MR671 11/2022