Original Medicare (Parts A & B): Principal Care Management Services
Disease-specific services to help someone manage a single, complex chronic condition.
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How To Receive
Details on how to apply
Ask a primary care provider about principal care management services to see if the member qualifies.
If they qualify, the primary care provider or another treating healthcare provider (such as a specialist) must accept principal care management assignment.
Together with the provider, develop a disease-specific care plan.
The care plan will be continuously monitored and adjusted.
Adhere to the interventions and goals as outlined in the care plan.
For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.
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What is a single, complex chronic condition?
An illness that
lasts for a prolonged period of time (3 months or more, and typically lifelong)
has multiple symptoms or systemic (whole-body) effects
requires multiple treatments, and usually the attention of multiple healthcare providers or facilities, and
possibly requires community- or home-based care
These conditions create unique needs, disabilities, or functional limitations in the person. Examples are heart failure, COPD, cancer, end-stage renal or liver disease, and diabetes plus one or more other conditions, among others.
Covered services
Medicare covers disease-specific services to help your loved one manage a single, complex chronic condition that puts you at risk of hospitalization, physical or cognitive decline, or death. If your loved one has one chronic high-risk condition that is expected to last at least 3 months (like cancer) and is not being treated for any other complex conditions, Medicare may pay for a healthcare provider's help to manage it. The provider will create a disease-specific care plan and continuously monitor and adjust it, including medications.
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