Private Geriatric Care Management vs. Medicare Coverage
Medicare does not cover private geriatric care management, which is a non-medical service usually paid for out-of-pocket. These private managers, often nurses or social workers, provide comprehensive services to coordinate a senior's care on an hourly basis. Their role includes managing complex medical issues and planning for long-term care. Since these are not direct medical services, Medicare considers them non-covered expenses, with costs potentially ranging from $150 to $350 per hour.
Covered Alternatives: Medicare's Chronic Care Management (CCM)
Although private geriatric care management is not covered, Medicare Part B does cover Chronic Care Management (CCM). This is a clinical service offered by healthcare providers to manage care for beneficiaries with multiple chronic conditions.
To be eligible for CCM, you must have two or more chronic conditions expected to last at least 12 months, which put you at significant health risk, and you must provide consent. Covered services include developing a care plan, 24/7 access to your care team, medication management, and coordination among providers. CCM is billed monthly by your provider and subject to the standard Part B deductible and coinsurance.
Other Medicare-Covered Services That Aid Senior Care
Medicare provides other benefits that support senior health and care coordination:
- Geriatrician Visits: Medicare Part B covers visits to a geriatrician for specialized care and health assessments.
- Annual Wellness Visits: These visits are fully covered and allow discussion of health goals and risk factors.
- Home Health Care: For eligible individuals, Medicare covers part-time skilled nursing and therapy at home. Home health agencies coordinate care with the doctor.
- Program of All-Inclusive Care for the Elderly (PACE): For those eligible for both Medicare and Medicaid, PACE provides comprehensive medical and social services, including care coordination, through an interdisciplinary team.
Comparing Care Coordination Services
| Feature | Private Geriatric Care Management | Medicare Chronic Care Management (CCM) | PACE Program |
|---|---|---|---|
| Covered By | Paid out-of-pocket, sometimes by long-term care insurance | Medicare Part B, after deductible and coinsurance | Integrated for Medicare/Medicaid dual-eligibles |
| Provided By | Private professional (nurse, social worker) | Your primary care provider's office staff | Interdisciplinary team through a PACE center |
| Eligibility | Open to anyone who can afford it | Two or more chronic conditions and consent | 55+, meet nursing home level of care, live in a PACE area |
| Focus | Holistic, non-medical support for family and patient | Clinical coordination for chronic conditions | All medical and social needs |
| Services Include | Assessments, long-term planning, family guidance, crisis management | Care plan, 24/7 access to care team, medication review | Doctor visits, hospital care, home care, meals |
| Medical Oversight | Provides coordination but not direct medical care | Directed by your primary care provider | Direct medical care and oversight by the PACE team |
Considerations for Medicare Advantage (Part C)
Medicare Advantage plans, which cover everything Original Medicare does, also do not cover private geriatric care management. However, some Part C plans may offer supplemental benefits that could include some care coordination services. It is essential to check the specific plan details or contact the provider directly.
Making the Right Choice for Your Family
Choosing how to coordinate care requires understanding your options. For managing chronic conditions, Medicare's CCM is a covered, medically focused service. If extensive non-medical support is needed, a private geriatric care manager may be necessary, involving out-of-pocket costs. For those with limited income, programs like PACE or local Area Agency on Aging services can provide support. Research and communication with family and providers are key to finding the best solution. More information on covered care coordination is available on the official Medicare website Medicare.gov.
Conclusion
Medicare does not cover private geriatric care management, which is a private, out-of-pocket expense. However, it offers covered alternatives like the Chronic Care Management (CCM) program for beneficiaries with multiple chronic conditions, which helps coordinate medical care and services. Understanding these distinctions helps families make informed decisions about senior care.
