Original Medicare (Parts A & B): Transitional Care Management Services
Help when your loved one is returning home after a hospital or skilled nursing facility (SNF) stay.
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How To Receive
Details on how to apply
Upon discharge from the hospital or SNF, ask your loved one's provider about transitional care management.
Follow through with any recommendations, referrals, and appointments made by the provider during the 30-day transition period.
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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Medicare may cover this service if your loved one is returning to the community (wherever they call home) after a stay at certain facilities.
The healthcare provider who's managing your loved one's transition back into the community will work to coordinate and manage their care for the first 30 days after returning home.
Your loved one will also receive an in-person office visit within 2 weeks of their return home.
The healthcare provider may also review information on the care your loved one received in the facility, provide information to help them transition back to living at home, work with other care providers, help with referrals or arrangements for follow-up care or community resources, help with scheduling, and help manage medications.
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