Does Medicare Cover Transitional Care Management?

Recovering from a hospital stay can be difficult. Consider a hip replacement or coronary artery bypass graft: After you return home, you may be physically weak and require assistance with activities of daily living. You may have complicated discharge instructions to follow. You may need other types of support to ensure that you can heal properly without being readmitted.  

Thankfully, transitional care management (TCM) is a Medicare-covered service that’s designed to keep you on track after you’re discharged.  

What Is Transitional Care Management? 

TCM refers to the services you need as you move from one care setting to another care setting or from one care setting back to your home. The healthcare provider managing this transition —often your primary care physician or internist — will work with you, your family, caregivers and other providers to ensure a smooth transition that usually includes a combination of education, care coordination and ongoing communication.  

TCM is tailored to you and your own health needs. 

Who Is Eligible for Transitional Care Management? 

Not everyone qualifies for TCM. You’re eligible for TCM if you are discharged to your home, domiciliary, rest home or assisted living facility from one of these types of facilities:  

• Inpatient acute care hospital 
• Inpatient psychiatric hospital 
• Long-term care hospital 
• Skilled nursing facility 
• Inpatient rehabilitation facility 

You’re also eligible after a hospital outpatient observation or partial hospitalization as well as a partial hospitalization at a community mental health center.  

However, the reason for your admission also plays a role in determining your eligibility. You’re eligible for TCM if you were admitted due to a medical and/or psychosocial problem that meets certain criteria based on your risk of complications, the amount of data your physician must review to care properly for you and other factors.  

Your physician will ultimately make this determination. TCM is meant for patients with conditions that require moderate- or high-complexity medical decision making. 

What Does Transitional Care Management Include? 

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In general, TCM includes 30 days of services related to the diagnosis for which you were admitted. Examples include assistance with referrals for follow-up care or community resources as well as help education about self-management and more. 

Here’s what you can expect: Within two business days following your discharge, your provider will contact you to check in and assess your recovery. They’ll also schedule an appointment either in person or via telehealth within seven or 14 days of your discharge depending on the complexity of your condition. 

How Can Transitional Care Management Help? 

TCM provides a foundation for a smooth and effective recovery. It ensures that all of your providers work together to provide you with the care you need to be successful. It also ensures that you have the support you need and that you understand and can follow through with post-discharge instructions (e.g., follow up appointments, medications, wound care, physical therapy, etc.). This type of ongoing support helps prevent you from being readmitted. 

Does Medicare Require Me to Receive Transitional Care Management? 

No. TCM is a voluntary service and is not required by Medicare. 

How Can I Get Transitional Care Management? 

If you’re going in for a planned surgery, your physician may already anticipate providing TCM services to you and can explain what those services will include. If you’re unsure whether TCM is part of the plan, simply ask your doctor.  

If the admission is unplanned, be sure to notify your doctor upon discharge so they can initiate TCM services immediately.  

How Much Will I Pay for Transitional Care Management? 

You will pay your Part B deductible and coinsurance. In 2021, the Part B deductible is $203 per year. Your Part B coinsurance is typically 20% of the Medicare-approved amount after you meet your deductible.