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Chronic Illness and Medicare—What You Need to Know
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What to Eat—or Not

According to UCLA Health, good nutrition is about going back to the basics. Talk to your doctor about:

  • Adding vegetables, whole grains, and foods with fatty acids such as fish
  • Reducing or increasing potassium from bananas or potatoes
  • Decreasing hidden salt (from store-bought bread, chicken, or cheese) and aiming for no more than 2 grams of sodium a day which helps support good heart and vascular health
  • Minimizing added sugars, along with sugar substitutes – by avoiding snacks or sodas and choosing foods with natural sugars, like fruits
  • Adding more plant-based meals – high in vegetables, whole grains, and nuts, seeds, or legumes
  • Drinking about 13 cups of water a day if you’re a man—9 cups of water a day if you’re a woman
  • Reducing alcohol and drinks with sugar to two or less in a day for a man—one or less in a day for a woman

With a chronic illness, taking care of yourself is your top priority. But sometimes, it can feel hard to get the care you need.

More than 60% of people with Medicare live with a chronic condition, according to the U.S. Centers for Disease Control. Medicare is working to grow its chronic care management services. Ready to take a new look at your care options? Here’s what you need to know.

Have diabetes?

As of January 1, 2024, your Medicare drug plan can’t charge you more than $35 for a one-month supply of each insulin product Part D covers. And you don’t have to pay a deductible for it.

If you take insulin through a traditional pump that’s covered under Medicare’s durable medical equipment benefit. And that insulin is covered under Medicare Part B. You won’t pay more than $35 for a month’s supply and the Medicare deductible no longer applies.

Have chronic pain?

New for 2024, Medicare covers monthly services for people living with chronic pain (persistent or recurring pain lasting longer than 3 months). Services may include pain assessment, medication management, and care coordination and planning. The Part B deductible and coinsurance apply.

Original Medicare covers manipulation of the spine by a chiropractor to correct a subluxation (when spinal joints fail to move properly, but the contact between the joints remains intact). Medicare also covers a set number of visits for acupuncture within 90 days for chronic low back pain when meeting Medicare’s criteria. For most pain management services, you pay 20% of the Medicare-Approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible also applies.

Medicare Advantage plans may offer additional acupuncture and/or chiropractic treatments.

Need help with added services?

You might need more help at home with a chronic condition.

Many Medicare Advantage plans cover additional services like companion care, health-related transportation, or a quarterly over-the-counter (OTC) benefit allowance, according to the National Council on Aging. Some Medicare Advantage plans also include allowances for groceries, help paying for utilities, and support fitness memberships and other social activities. Check the plan’s details. All plans differ and depends on the type of Medicare Advantage plan selected and the location.

Have a specific condition?

Look into a Medicare Special Needs Plan (SNP). It’s a type of Medicare Advantage plan that provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid coverage. SNPs tailor their benefits, provider choices, and list of drugs (formularies) to best meet the specific needs of the groups they serve. Your costs may also be lower.

You must live in the plan’s service area and have Medicare Parts A and B to qualify. There are three different types of SNPs.

  • C-SNP: for those who have a severe or disabling chronic conditions (like diabetes, heart failure, End-Stage Renal Disease (ESRD), HIV/AIDS, dementia, and certain neurological disorders).
  • I-SNP: for those who live in certain institutions (like nursing homes), or who live in the community but need nursing care at home.
  • D-SNP: for those eligible for both Medicare and Medicaid.

Have two or more serious chronic conditions?

If you have two or more serious chronic conditions (like arthritis and diabetes) that you expect to last at least a year, Medicare may pay for a health care provider’s help. If your providers offer Chronic Care Management Services, or CCM they’ll manage your care for those chronic conditions.

Chronic Care Management Services includes a comprehensive care plan. Through this program, your doctor, nurse practitioner or physician assistant puts together a care plan that includes:

  • Your health problems and goals
  • Your providers
  • Your medications
  • Care you need
  • Community services you need
  • How care will be coordinated

If you agree to get this service, your provider will prepare the care plan for you or your caregiver, help you with medication management, provide 24/7 access for urgent care needs, give you support when you go from one health care setting to another, review your medicines and how you take them, and help you with other chronic needs.

To get started, ask your health care providers if they offer Chronic Care Management Services. You pay a monthly fee, and the Part B deductible and coinsurance apply. If you have supplemental insurance, including Medicaid, it may help cover the monthly fee.

Have more questions?

You have another partner you can turn to — our licensed insurance agents. They’ll help you find the answers you’re looking for. Making it easier to get the health care you need for your chronic condition.

Give us a Call

1-844-672-0317 (TTY: 711)
Monday-Friday
9 AM to 6 PM ET

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