Medicare covers transitional care management to support your transition home after discharge from a medical facility. Services include scheduling follow-ups and coordinating care.
Transitional care management (TCM) assists with transitioning from a hospital or other medical facility to your community or home. During the transition period, a healthcare professional supervises and coordinates your care. TCM lasts 30 days after discharge when complex medical decisions must be made.
This service is particularly important for older adults with multiple chronic conditions or complex treatment regimens. According to a
- reduce negative effects
- increase post-discharge follow-up
- lower costs for care
- lower readmission rates
Medicare first began to cover TCM in 2013. According to a
Keep reading to learn more about Medicare coverage of TCM, what types of services are provided, and how to qualify.
Medicare covers TCM when it’s coordinated by a healthcare professional who’s approved by Medicare.
TCM services are covered under Medicare Part B (medical insurance), which covers various outpatient services and some preventive care services.
Under Part B, you’ll be responsible for paying these costs:
- Part B monthly premium: Your monthly premium is the amount you pay monthly for your Part B coverage. The standard Part B monthly premium for 2024 is $174.70.
- Part B deductible: A deductible is the amount you must pay out of pocket before Part B begins covering services like TCM. The 2024 Part B deductible is $240.
- Coinsurance: Coinsurance is the portion of the cost you pay for covered services after you’ve met your Part B deductible. You’re typically responsible for paying 20% of the Medicare-approved amount for Part B.
TCM involves a face-to-face visit with the healthcare professional managing your transition within 2 weeks of discharge. During this period, they may communicate with you at home via telephone or email.
Medicare Advantage (Part C) is a health insurance option offered by private companies and approved by Medicare. A Medicare Advantage plan must provide the same basic level of coverage as Original Medicare, which includes Part A and Part B.
Because of this, Medicare Advantage plans also cover TCM. These plans may also cover additional services you might use during your transition, such as transportation to outpatient appointments and meal deliveries. You can check with your plan provider for additional details about coverage.
Depending on your plan, Part C costs may differ from those of Original Medicare. Additionally, many plans require the use of an in-network provider. Check that all your providers are in network before setting up TCM services.
The overall goal of TCM is to work with you, your family, and other caregivers to help ensure a smooth transition back to your home. This can help both improve your quality of life and prevent unnecessary readmissions.
TCM coverage lasts for 30 days following discharge from a medical facility. During this time, the healthcare professional managing your transition will do the following:
- directly communicate with you or your caregiver within 2 business days of discharge, either in person, by telephone, or through email
- provide medical decision making for situations with a moderate to high amount of complexity
- set up an in-person visit within 2 weeks of your return home, either at a doctor’s office or another outpatient healthcare facility (or, in some cases, in your home)
They may also offer other services during this 30-day period. These aren’t typically provided in person but can include things like:
- going over the types of care you received while you were in the medical facility
- verifying whether you may need any additional follow-ups or diagnostic tests
- working alongside your other healthcare professionals to help better streamline your transition back home
- assisting with the management of your medications
- making referrals or arranging for medical appointments or other health-related services
- identifying community resources that may be helpful
- providing you and your caregivers with additional information on ways to promote independence and your ability to perform daily activities
To qualify for TCM coverage through Medicare, you must first be enrolled in either Original Medicare or a Medicare Advantage plan.
You must be current on your payments if you’re already enrolled in Medicare. Not paying your Medicare bills or premiums in a timely manner can cause you to lose your coverage.
TCM can be provided to those with medical or psychological conditions that require decision making of a moderate to high level of complexity.
For example, if you have multiple chronic health conditions, TCM may be used after a period of hospitalization. Another example is when someone first returns home or to a community after a stroke.
TCM services are given when you’re transitioning back home from specific types of medical facilities, such as:
- hospitals, including after inpatient care, partial hospitalization, or outpatient observation
- inpatient mental health facilities
- skilled nursing facilities
- inpatient rehabilitation facilities
- long-term care hospitals
Types of healthcare professionals who can provide TCM services include:
- physicians
- physician assistants
- nurse practitioners
- clinical nurse specialists
- certified nurse midwives
TCM services last for 30 days following your discharge. Additionally, they must be given by a provider who accepts Medicare. To locate providers and facilities that accept Medicare, use Medicare’s physician comparison tool.
If you have additional questions or concerns about TCM, the resources below can help you to address them.
- Medicare: You can contact Medicare directly with specific questions by calling 800-633-4227 or by logging into your Medicare account.
- Your Medicare Advantage plan provider: If you have a Medicare Advantage plan and have specific questions about coverage or payments, contact your plan’s provider directly.
- Social Security: If you have questions about Medicare eligibility or enrollment, contact the Social Security Administration by calling 800-772-1213 or visiting your local Social Security office.
- State Health Insurance Assistance Programs (SHIPs): SHIPs provide assistance and counseling to people with Medicare and can help answer your questions. Search for your state’s SHIP here.
- Medicaid: Medicaid helps those with low income and resources pay for healthcare-related costs. The eligibility requirements and services covered vary by state. Find your state Medicaid agency here.
TCM helps streamline your transition from a medical facility to your home or residential community. A healthcare professional offers these services in the 30 days following your discharge.
TCM services can include:
- an in-person visit
- medication management
- scheduling follow-up visits
- coordinating with your other healthcare providers
Medicare Part B covers TCM services. They’re also covered if you have a Medicare Advantage (Part C) plan. The exact costs of TCM can depend on what type of Medicare coverage you have.
If you have questions about TCM and Medicare, don’t hesitate to contact Medicare or your plan’s provider directly. You can also use resources like your state’s SHIP or Medicaid office to get more help.