Medicare.gov

Advanced Primary Care Management services

Medicare Part B (Medical Insurance) covers Advanced Primary Care Management services to help your doctor and other health care providers coordinate and tailor care to your needs

  • Covered by Part B

  • Monthly

  • After the Part B deductible , you pay 20% of the Medicare-approved amount

Description

Advanced Primary Care Management is a patient-focused approach to care. Health care providers who offer Advanced Primary Care Management services take extra steps to actively manage all your health care needs. When you get these services, you and your primary care provider (or care team) agree that they’ll be your main point of ongoing care. They’ll talk to you about your care plan and coordinate all your health care needs, including care you get from other doctors, hospitals, and providers.

Providers that offer these services must provide you with:

  • 24/7 access to your care team or provider through the phone, an online portal, email, and virtual check-ins
  • Chronic care management
  • A personalized care plan that lists your current conditions and treatments
  • Comprehensive care coordination to quickly connect you with specialists and other providers
  • Transitional care between health care settings (like follow-up are after you're discharged from a hospital)
  • Medication management
  • Behavioral health integration services (including the Psychiatric Collaborative Care Model) 
     

Coverage details

  • Check with your primary care provider to make sure they offer these services. Then, give your provider verbal or written consent to be your main point of care for all your health needs. They’ll document your consent on your medical record. You must also have an initial visit with your provider unless:
    • You've gone to the provider or another provider in the same practice within the last 3 years.
    • You got another type of care management (like chronic care management) from the provider or another provider in the same practice within the last year.
  • You can stop getting services at any time. Talk to your provider to stop participating.

Adding providers to your secure Medicare account at Medicare.gov lets you store all your provider contact information in one place. Log into (or create) your Medicare account at any time to add providers and select one as your primary health care provider.

Costs

After you meet the Part B deductible , you pay 20% of the Medicare-approved amount . Many people who have both Medicare and Medicaid pay nothing for these services.

If you have a Medicare Advantage Plan , your costs for these services might be different. Contact your plan for specific cost information.

How often

Monthly

Ask your doctor or healthcare provider how much your test, item, or service will cost.

Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.

Specific amounts you could owe depend on:

  • Other insurance you may have

  • How much your doctor charges

  • If your doctor accepts assignment

  • The type of facility

  • Where you get your test, item, or service

Other related information