Yes, Medicare does have case managers, but whether one is assigned to you automatically depends on your coverage. If you’re enrolled in a Medicare Advantage plan or a Special Needs Plan, you likely have access to a dedicated case manager or care coordinator through your insurer. If you have Original Medicare, the same kind of coordination work is handled by your doctor’s office under programs Medicare pays for separately. In either case, you can ask for these services directly instead of waiting for someone to offer them.
Case Managers in Medicare Advantage Plans
Medicare Advantage plans are the private insurance alternative to Original Medicare, and they’re the version of Medicare most likely to give you a person you’d actually call a case manager. Federal regulations require these plans to ensure continuity of care, coordinate with community and social resources, and attempt an initial health assessment within 90 days of enrollment.1eCFR. 42 CFR 422.112 – Access to Services Many plans go further than the minimum and staff case managers who act as your single point of contact.
A case manager handles the logistics that overwhelm many beneficiaries: scheduling specialist appointments, arranging transportation, flagging medication conflicts, and making sure test results don’t sit in one doctor’s file while another doctor orders the same tests. They typically check in periodically and review your health records to spot problems before they become emergencies. If you’re in a Medicare Advantage plan and no one has offered you a case manager, call the Member Services number on your plan card and ask. That request matters most if you’re managing several conditions or have had a recent hospitalization.
Special Needs Plans Assign a Care Coordinator Automatically
Special Needs Plans are a category of Medicare Advantage built for people whose situations demand more hands-on management than a standard plan provides. There are three types: Dual Eligible plans for people who qualify for both Medicare and Medicaid, Chronic Condition plans for people with specific severe illnesses, and Institutional plans for those living in long-term care facilities like nursing homes.2Medicare.gov. Special Needs Plans (SNP)
Every Special Needs Plan is required to assign a care coordinator to each member and develop an individualized care plan.2Medicare.gov. Special Needs Plans (SNP) The plan must follow an evidence-based Model of Care using an Interdisciplinary Care Team that draws on physicians, nurses, social workers, and specialists suited to the enrolled population. The care plan is reassessed regularly, and health risk assessment results guide how the team adjusts as your condition changes.
For dual-eligible beneficiaries, coordination is more complicated because Medicare and Medicaid may each be paying for different services. In states with aligned plans, the Medicare D-SNP and the Medicaid plan are expected to share information about hospital admissions, discharge planning, and changes in your condition, and the care coordinators are usually trained on how both programs interact.3Centers for Medicare & Medicaid Services. Dual Eligible Special Needs Plans (D-SNPs)
Care Coordination Under Original Medicare
Original Medicare doesn’t assign you a case manager the way a private plan might. It pays your doctor’s office to do the same work under two programs: Chronic Care Management and Principal Care Management. Organizing your medications, keeping specialists in touch with each other, and building a care plan you can actually follow all happen through your primary care provider’s clinical staff instead of through a separate person at an insurance company.
Chronic Care Management
Chronic Care Management is available if you have two or more serious chronic conditions expected to last at least a year, such as diabetes, heart disease, or arthritis.4Medicare.gov. Chronic Care Management Services Your doctor’s office handles the coordination on a monthly basis, reviewing your medications, following up between visits, and keeping your treatment plan on track. Federal law authorizes Medicare to pay for these services and limits billing to one provider per calendar month, so your care stays centralized rather than fragmented across multiple offices.5Office of the Law Revision Counsel. 42 USC 1395w-4 – Payment for Physicians Services
Before billing begins, your provider must get your consent. You’ll be told that only one practitioner can bill for these services in a given month and that you can stop at any time, effective at the end of the calendar month. Consent is given once unless you switch providers. After you agree, your provider develops a comprehensive care plan that should be in place before the coordination work really begins.
Principal Care Management
If you have just one serious chronic condition expected to last at least three months, such as cancer or COPD, and you aren’t being treated for other complex conditions, you may qualify for Principal Care Management instead.6Medicare.gov. Principal Care Management Services The setup is similar to Chronic Care Management, but the focus is a single high-risk condition rather than several at once.
Transitional Care Management After a Hospital Stay
One of Medicare’s most underused coordination benefits kicks in right after you leave the hospital. Transitional Care Management covers 30 days of follow-up starting the day you’re discharged, and it exists to prevent the kind of confusion that leads to readmissions: missed medications, unclear instructions, no one following up on what happened during the stay.7Centers for Medicare & Medicaid Services. Transitional Care Management Services Booklet
Your provider’s office must contact you within two business days of discharge. Clinical staff need to check on your condition and immediate needs, and if they can’t reach you, they’re required to keep trying. After that first contact, you’ll have a face-to-face visit with your provider within either 7 or 14 days, depending on how complex your situation is. Your provider must also reconcile your medications on or before that visit, so any conflicts between what you were taking before the hospital and anything new get caught.7Centers for Medicare & Medicaid Services. Transitional Care Management Services Booklet
Most beneficiaries don’t know this program exists, so it often doesn’t happen unless your doctor’s office is proactive. If you or a family member has a hospital discharge coming up, tell your primary care provider directly and ask them to bill for transitional care management. That single request can trigger the entire coordination process.
How to Request a Case Manager
The right starting point depends on your coverage. A few things will speed up the process either way: your Medicare or plan ID card, a current list of medications with dosages, and the names and contact information of all your treating providers.
If You Have Medicare Advantage or a Special Needs Plan
Call the Member Services or Care Coordination number on your plan ID card. Many plans also have an online member portal with a section for requesting care management. Ask specifically about being assigned a case manager or care coordinator. Plans are required to coordinate your care, but the squeaky wheel gets the dedicated contact person. If you think you’re eligible for a Special Needs Plan but aren’t currently in one, Member Services can explain your options or point you to enrollment resources.
After your initial request, expect a follow-up call from a nurse or care coordinator who will walk through your medical history, health goals, and any barriers to getting care, including transportation problems, trouble affording medications, or difficulty keeping track of specialist appointments. From that assessment you should receive a written care plan with your goals and the schedule for ongoing check-ins.
If You Have Original Medicare
Start with your primary care doctor. Ask whether their office offers Chronic Care Management or Principal Care Management. Not every practice has set up the billing infrastructure for these programs, so if yours hasn’t, you may need to find one that has. Your doctor will evaluate whether you meet the clinical criteria, explain your cost-sharing responsibility, and ask for your consent.4Medicare.gov. Chronic Care Management Services Once you consent, the office develops your care plan and begins the monthly coordination work. Ongoing check-ins can happen by phone or video, so you don’t need to be in the office every month.
What Case Management Costs
Care management services under Original Medicare are billed under Part B, so standard cost-sharing applies. In 2026, the Part B deductible is $283. Once you’ve met the deductible, you pay 20% of the Medicare-approved amount for Chronic Care Management, Principal Care Management, and Transitional Care Management.8Medicare.gov. Medicare and You 2026
A Medigap (Medicare Supplement) policy typically covers the 20% coinsurance, which may bring your out-of-pocket cost to zero. Medicaid can also cover the cost-sharing for dual-eligible beneficiaries. Your provider must inform you about potential cost-sharing before you consent, so there shouldn’t be a surprise on your first bill.
Medicare Advantage plans set their own cost-sharing rules, which may differ from Original Medicare’s 20% coinsurance. Check your plan’s Evidence of Coverage document, which your plan mails each fall and which spells out what you’ll owe.9Medicare.gov. Evidence of Coverage (EOC) Many Advantage plans include care management at no additional cost.
If You’re Denied or Ignored
If a Medicare Advantage plan denies your request for care coordination services, you have the right to appeal. You or your doctor can request a reconsideration from the plan within 65 calendar days of the denial notice. Standard requests generally must be in writing, though some plans accept verbal requests, so check your Evidence of Coverage. If a physician requests an expedited reconsideration, the plan is required to fast-track it.10Centers for Medicare & Medicaid Services. Reconsideration by the Medicare Advantage (Part C) Health Plan
If your complaint isn’t about a denied service but about the quality of the coordination you’re receiving, like a case manager who never calls back or dropped referrals, that’s a grievance rather than an appeal. You can file a grievance directly with your plan, and you can also contact Medicare at 1-800-633-4227 to report the issue.
Free Help Sorting Through Your Options
Every state has a State Health Insurance Assistance Program that provides free, one-on-one counseling to Medicare beneficiaries. SHIP counselors can help you figure out which care management programs you qualify for, compare plan options, and resolve billing problems. Counseling is available by phone or in person, and it’s funded by CMS, so counselors aren’t selling anything. You can find your local SHIP office by visiting medicare.gov or calling 1-800-633-4227.