Is Transitional Care Management Only for Medicare Patients?
- Solstice HC
- Jul 10
- 4 min read
Updated: Aug 5
Transitional Care Management is a health care approach designed to support patients after they leave a hospital or care facility. The goal is to reduce readmissions and keep recovery on track. The first 30 days after discharge are often the most critical. Patients need help managing medications, scheduling follow-up visits, and adjusting to being home again.
CMS introduced the concept in 2013 through a structured program. It uses defined codes to reimburse physicians and care teams for overseeing patients’ transitions from hospital to home. These codes reflect the complexity of care needed and ensure providers are fairly compensated for the coordination involved.
In Utah, this approach plays a big role in managing chronic illnesses and supporting people with limited mobility or medical complications. At Solstice, our trained team ensures that this hand-off is smooth, safe, and centered on the patient’s health goals.
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Who Can Benefit From TCM Services?
While Medicare was the first to back Transitional Care Management, it's not limited to seniors alone. Adults under 65 living with disabilities or severe health conditions may also qualify. Those diagnosed with ALS or end-stage renal disease, for example, can receive Medicare earlier and access TCM services.
But eligibility goes beyond government programs. Many private health plans and Medicaid options now recognize the value of coordinated transitional care. They offer similar support structures to prevent unnecessary hospital stays and improve patient outcomes.
That means younger adults recovering from surgeries, injuries, or long hospitalizations can benefit from TCM too. When a person receives guidance through home visits, remote check-ins, and medication reviews, recovery becomes safer and more effective.
Solstice sees firsthand how important these steps are. By responding early to potential setbacks, we help patients stay at home longer and avoid repeat hospital visits.
Expanding Access Beyond Medicare
Insurance providers are seeing the long-term value of Transitional Care Management in Utah. Many now pay for services similar to Medicare’s model. CPT codes 99495 and 99496 cover different levels of care complexity and allow clinicians to be reimbursed based on the patient’s medical needs.
Medicare Advantage plans have adopted TCM to improve their own performance ratings. These plans rely on positive health outcomes to earn higher star ratings from Medicare, and transitional care plays a large role in achieving that.
Medicaid plans and Managed Care Organizations also offer TCM for various age groups. In fact, younger Medicaid patients experience hospital readmissions at similar rates as older Medicare beneficiaries. That shows a clear need for structured care transitions across all age groups.
Some commercial insurers take things a step further. They support transitional care after ER visits or provide longer-term support beyond the initial 30-day window. Utah health systems often use electronic alerts to follow up quickly after discharge and deliver care that’s both timely and effective.
Solstice embraces these partnerships by coordinating closely with insurance providers. Our team delivers transitional care that meets both medical standards and human needs.
Why Transitional Care Management Matters?
Utah faces unique healthcare challenges. The population includes a high number of elderly individuals and adults with chronic illnesses. Geography also plays a role. For many families, traveling to a clinic or specialist is not always possible.
That’s where Transitional Care Management becomes vital. It reduces barriers and ensures patients can recover in the safety and comfort of their homes. With services that begin immediately after hospital discharge, patients are less likely to miss medications or follow-up appointments.
At Solstice, we specialize in these transitions. Our care team includes nurse practitioners, aides, and volunteers trained to address complex needs. Whether it’s wound care, medication assistance, or fall prevention, we focus on creating a care plan that works.
Many families don’t realize that transitional care is an option until after a crisis. Solstice helps make that conversation easier. We work with physicians and insurance providers to activate TCM as soon as a patient qualifies. This way, no time is lost, and recovery starts with the right support.
The Bottom Line
Transitional Care Management is not only for Medicare patients. With more providers and insurers embracing this model, patients of all ages are seeing the benefits. From reduced readmissions to better long-term outcomes, TCM makes a difference.
Solstice leads with experience and compassion. Our team works across settings, from hospital discharges to home health care, ensuring that every step of recovery is supported. We serve Salt Lake City and surrounding areas with dedication and pride.
We believe people deserve quality care at every stage of life. Whether you’re helping a parent come home from the hospital or recovering yourself, Solstice is here to help. TCM is more than a billing code; it’s a promise of continued care and commitment to health.
Frequently Asked Questions
Is Transitional Care Management available in Utah outside of Medicare?
Yes. Transitional Care Management in Utah is also covered by many commercial insurers and Medicaid programs. These providers recognize its value in reducing hospital readmissions and improving patient outcomes, extending access beyond just Medicare beneficiaries for better healthcare coordination.
How do I know if I or my loved one qualifies for TCM?
You may qualify if recently discharged from a hospital and require moderate or high medical decision-making. Solstice can help verify eligibility based on your insurance coverage, condition, and discharge details. Reach out to our care team for a personalized review.
What happens during the 30-day TCM period?
The 30-day period includes remote and in-person follow-ups, medication reconciliation, and coordination with your physician. These services ensure proper recovery, reduce risks, and help avoid readmissions. Solstice supports patients during this time with personalized attention and compassionate care planning.
Does Solstice offer Transitional Care Management?
Yes. Solstice provides full Transitional Care Management services across Utah. Our experienced caregivers and nurses work directly with hospitals, patients, and insurers to deliver seamless support after discharge, making recovery at home safer, more comfortable, and medically supervised.
Can younger patients receive transitional care services?
Yes. Patients under 65 with disabilities or serious conditions often qualify through Medicaid or commercial insurance. Transitional care is not limited to seniors. Solstice supports younger adults through recovery with personalized care that improves outcomes and prevents repeat hospital stays.
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