Empower Your Health Journey: Understanding Medicare’s Role in Managing Chronic Conditions
Keeping up with your Medicare options can be overwhelming, especially if you’re navigating a serious health condition. Medicare offers a host of support for beneficiaries with chronic conditions, from personalized care coordination to guidance on fitness and nutrition. We’ll help you explore your options so you can maximize your benefits.
Chronic Conditions in the US
If you’re managing a chronic condition, you’re not alone. According to the CDC, approximately 60% of US adults live with a chronic condition. Tens of millions live with two or more. There are many different conditions that can be considered chronic, including:
• Alzheimer’s disease
• Arthritis
• Cancer
• COPD
• Depression
• Diabetes
• Heart disease
• Obesity
With a chronic condition comes the need for more extensive healthcare, from medication to appointments with specialists. You may find over time that you need assistance with mobility or managing your care coordination. Additionally, the need for healthy lifestyle guidance is critical.
If you’re turning 65 soon or are interested in changing or expanding your Medicare coverage, it’s important to find a plan that provides the full scope of care that you’ll need, especially if you are managing one, or multiple chronic conditions.
Exploring Your Medicare Options
There are a number of Medicare plans to consider, including Original Medicare and Medicare Advantage, along with private and specialized plans. Original Medicare – or Part A and B – covers hospital and medical insurance, and you’re free to receive care from any US doctor or hospital that takes Medicare. This may work for you if you’ve been seeing the same physician for years and hope to keep them a part of your health journey.
It’s important to note however that Original Medicare does not include coverage for prescription medication. One way to resolve this is to secure a Medicare Part D plan, which specifically focuses on coverage for both brand-name and generic medication. Each Part D plan includes its own formulary, which is the list of medications it covers. It’s crucial to confirm that your plan provides coverage for your medications before choosing one.
There’s also Medicare Advantage, or Part C. Medicare Advantage includes Part A, Part B, and coverage for medication. With a Medicare Advantage plan, usually access is limited to in-network providers, which may be a dealbreaker for some. However, some Medicare Advantage plans include dental, vision, and hearing benefits. If your condition or the medications you take cause complications in these areas, you may want to consider enrolling in a Medicare Advantage plan.
Before choosing a Medicare plan, think about how your condition affects your everyday life and any specialized care you may need in the upcoming year. What types of medication do you need? Do you anticipate that you’ll need surgery, physical therapy, or transportation to and from appointments? Considering all these details can help you choose a plan that’s aligned with your needs.
Navigating CCM, PACE, and SNPs
If you’re a Medicare beneficiary and you live with two or more chronic conditions, you may be eligible for additional support through Medicare’s Chronic Care Management Services, or CCM. These resources are available to individuals whose conditions are expected to be life-long or last for at least 12 months.
CCM resources include 24/7 emergency access to a healthcare professional, along with monthly phone check-ins and personalized care coordination between your specialists, pharmacy, and other aspects of your care.
Medicare’s PACE Program – or Program of All-Inclusive Care for the Elderly – may also be helpful for seniors with chronic conditions. PACE includes a broad scope of both medical and wellness services, including primary care, hospital care, adult day care, nutritional counseling, and recreation therapy.
In order to be eligible for PACE, individuals must be over 55, meet the eligibility requirements for nursing home care, and be able to live safely in their community. As PACE programming is provided at designated PACE organizations, beneficiaries must also live within a service area.
Medicare also provides Special Needs Plans, or SNPs. There are several SNPs, including C-SNPs, which are tailored specifically for certain chronic conditions. All SNPs provide Part D medication coverage, though other details – like premiums and provider options – vary by plan. SNPs include care coordination services and may include additional coverage specific to your condition.
Chronic Disease: A Healthy Lifestyle Is Essential
Whether you experience chronic pain from arthritis or you’re living with diabetes, a healthy lifestyle can help you better manage your symptoms and prevent complications or additional chronic illnesses. In addition to being proactive with your healthcare, key components of healthy aging include exercise, nutrition, sleeping well, and staying away from harmful habits like smoking.
Preventive care is so important at any age or stage. Medicare provides coverage for vaccines for the flu, COVID-19, RSV, and more, helping to safeguard you from serious illness. Medicare also provides coverage for preventive screenings like mammograms and screenings for cervical or prostate cancer. Again, be sure to double-check your plan to make sure each service is provided.
If you’re living with chronic pain, it may be tough motivating yourself to stay active – but it can make a world of difference. This resource from Mayo Clinic provides great insights on the benefits of exercise for individuals with chronic disease. For example, regular exercise can improve your range of motion, strengthen your cognitive skills, and alleviate symptoms of depression and anxiety.
While gym memberships and fitness programs are not included in Original Medicare, you can access these benefits through some Medicare Advantage plans or programs like PACE. And when it comes to nutrition, certain plans provide support in that area, as well. For example, Medicare Part B provides diabetes self-management training, which includes education on monitoring your blood sugar and eating healthy.
There are many services provided by Medicare designed to help you manage your chronic condition(s) and thrive, but sorting through the details can be challenging. From emergency care to everyday support, our team will listen to your cares and concerns and help you secure the coverage you need. Connect with our team for a consultation.
