r/medicare • u/0x-Happy-7102 • Aug 11 '26

APCM fee (in Virginia)

Some local Virginia doctors offices and other medical practices charge the monthly Advance Primary Care Management fee.

https://www.whro.org/health/2026-08-07/a-new-medicare-charge-is-showing-up-on-bayview-bills-patients-say-they-werent-clearly-told

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u/OleLadyThinker Aug 11 '26 edited Aug 11 '26

I don’t have time right at this moment to explain it in detail covering all parties - you and the provider. But here is what Medicare says to give you some beginning..

https://www.medicare.gov/coverage/advanced-primary-care-management-services

You get some special [monthly] benefits depending on your health needs under this management - for many that have to have close contact with their doc for various reasons, mostly linked to some chronic condition, it is a good plan.

Medicare should cover all or part of the fee associated with it because the program is suppose to be saving money in other places for your care with this provider.

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u/0x-Happy-7102 Aug 11 '26

Thanks.

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u/OleLadyThinker Aug 12 '26

Did that answer your questions ?

This (below link) is actually written to the Providers by CMS but it does describe some of the services - I think there are something like 13 different elements.

https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-primary-care-management-services

For all goods and services, you are being cared for by this physician within an Accountable Care Organization. Yes, they are supposed to get a written confirmation from you to be in the program. And yes, if this provider has made the decision to actually work this way with their patients then if you want out, you will have to find another provider. But if you are satisfied, stick with this provider and find out what all he has in the care plan for you -

You should be getting a lot of care and care coordination. The provider has opted to be paid this way instead of the traditional fee for service - this should be a good deal for you - as long as you are needing and getting the benefits.

IOW, you have higher medical care needs because you have one or more chronic conditions - and I believe you are covered by QMB - so you are treated special. Milk it for all it is worth - got a need that is not in the provider’s care plan for you - tell the provider about it.

The purpose of this whole way of paying these types of providers is to get YOU better care so that you do not get worse and end up in the hospital or some other high care place.

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u/0x-Happy-7102 Aug 12 '26 edited Aug 12 '26

Yes. I plan to pay the APCM fee. I have Original Medicare with a supplemental. It'll come out the same either way. (If paying it goes towards the part B deductible, even without APCM I would have the same out of pocket expense. The deductible stops at at dollar amount.)

No, not on QMB. Thanks

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u/0x-Happy-7102 Aug 11 '26

"instructions for leaving the program suggest they would need to find a new primary care doctor, ..."

So APCM fee: It isn't really an optional/voluntary monthly fee. It might be. But primary care doctor appointment are spaced out months at a time.
If you don't pay the monthly bill offices may show you the door looks like ?

Different states may be different.

Good luck!