Concierge Health Care for Seniors

How much would you pay for concierge like health care between office visits to get on track with your health goals? What if I told you it’s less than annual membership at a local gym.

In 2015, the Centers for Medicare & Medicaid Services started a new program called Chronic Care Management or CCM to promote better health. This service is available to Medicare beneficiaries and CMS just made it easier for you to enroll with your primary care physician.

So, what is CCM anyway? Medicare defines an eligible beneficiary as someone who has 2 or more chronic conditions. What Medicare beneficiaries don’t realize is that more than 50% of all seniors over 65 have at least 1 chronic condition and 7 of 10 have 2 or more chronic conditions. What’s a chronic condition? There are over 26 chronic conditions and Medicare defines them as diabetes, high blood pressure, arthritis, asthma, cataracts and heart disease just to name a few. Many are a effect of poor lifestyle choices such as smoking and alcohol use. Others result from lack of exercise, poor diet or environmental factors. Some may simply be genetics or a cause of a prior medical condition.

Depending upon the complexity of your chronic condition, your will have at least 20 minutes of non face-to-face service each month with a personal healthcare professional. That’s 24/7 access by phone, video or secure text and email messaging. Your personal health coach will create a customized care plan based on your needs, set goals then coordinate care between your doctor, pharmacy, testing labs, specialists and caregivers. They will check in with you between visits to the doctor’s office, provide education material to address specific needs and include family members if necessary.

The Value Proposition for a Medicare beneficiary to participate in CCM is invaluable. Just think, you no longer have to schedule the next office visit days or weeks in advance or find yourself at the back of the line in the ER or walk-in clinic. You probably spend the better part of a day if you add all the time it take traveling to and from the doctor’s office then wait in the reception area or exam room to be seen. And, what’s it worth to have your own personal health coach that you can discuss your health goals?

The average annual co-pay for CCM in New Jersey is about $110. According to the Kaiser Family Foundation, nearly 90% of Medicare beneficiaries have some form of supplemental or gap insurance to covers this cost. Your primary care physician may not communicate this information when you enroll so calling your supplemental plan is always a good idea.

As a Medicare beneficiary with a supplemental plan, not only is my gym membership covered for under a program called Silver Sneakers but my personal health coach is paid for as well.

How do you take advantage of the new Medicare program? Ask your doctor during your next face-to-face visit or go to the CMS website at www.cms.gov and search on CCM.