Benefits of Medicare’s CHI and PIN Programs

Introduction

Managing healthcare can be overwhelming, especially if you are living with a chronic illness, a serious diagnosis, or daily challenges that make it harder to get the care you need. Medicare recognizes these challenges and has introduced two important programs to help: Community Health Integration, also called CHI, and Principal Illness Navigation, also called PIN.

Both CHI and PIN are Medicare covered services designed to support patients beyond standard medical visits. CHI helps address nonmedical barriers to care such as transportation or housing issues, while PIN focuses on medical navigation for serious high risk conditions like cancer, COPD, or advanced heart failure. If you are unsure whether you qualify, you can read a full guide to CHI and PIN in the resources listed in the References section.

What Is Medicare’s Community Health Integration, CHI

Community Health Integration is designed for Medicare patients whose health is impacted by social determinants of health. These are nonmedical challenges that can interfere with following a care plan. Examples include:

• Difficulty getting to appointments
• Unstable housing or unsafe living conditions
• Lack of access to healthy food
• Social isolation
• Missing medical equipment or supplies

By addressing these issues, CHI ensures that your healthcare plan works in the real world. It is about more than prescriptions and appointments. It is about removing the everyday obstacles that can make managing your condition harder. For full details on how it works and who qualifies, see the CHI resource in the References section.

What Is Medicare’s Principal Illness Navigation, PIN

Principal Illness Navigation is focused on Medicare patients with serious high risk health conditions that require frequent medical care, complex treatment plans, or close monitoring. This program offers:

• Personalized navigation support from trained professionals
• Coordination between multiple specialists and care providers
• Referrals to community resources that support your health goals
• Ongoing education so you can better understand your condition

PIN is especially valuable for illnesses such as cancer, congestive heart failure, COPD, dementia, or severe mental health conditions. It helps reduce hospital visits, manage complicated treatment schedules, and connect you to support networks. You can learn more about PIN in the References section.

The Key Benefits of CHI and PIN Programs

Better care coordination

For many patients, healthcare involves multiple doctors, specialists, and caregivers. Without proper coordination, important details can get lost, which can lead to missed treatments or conflicting instructions.

• In CHI, care coordination often means aligning your healthcare with community services such as transportation or meal delivery.
• In PIN, care coordination means making sure your medical providers are on the same page about your treatment plan.

This coordinated approach helps prevent gaps in care and keeps your health on track.

Easier access to resources

Both programs go beyond traditional Medicare services to connect you with resources you may not know are available.

Examples of CHI resource support:

• Arranging rides to medical appointments
• Providing information on housing assistance programs
• Connecting you to local food pantries or meal delivery services

Examples of PIN resource support:

• Finding a cardiac rehab program after heart surgery
• Referring you to mental health counseling after a diagnosis
• Coordinating home health nursing for ongoing treatment

Reduced hospital visits and emergencies

By proactively addressing medical and non-medical needs, CHI and PIN help reduce unnecessary emergency visits and hospital admissions. This improves health outcomes and lowers costs and stress.

Example:
A patient with COPD who lacks reliable transportation might miss follow up visits, which can lead to flare ups and hospitalizations. With CHI, transportation is arranged, preventing missed care and reducing hospital risk.

Personalized support for your situation

No two patients are alike. CHI and PIN tailor services to your specific health conditions, home environment, and lifestyle.

• CHI might focus on making sure you have the right medical equipment at home.
• PIN might focus on adjusting your treatment plan after reviewing lab results with your specialist.

This personalized approach helps you feel supported and understood.

Lower stress for patients and caregivers

When you are managing serious health challenges, even small obstacles can feel overwhelming. CHI and PIN remove barriers so you can focus on getting better.

Caregivers also benefit from reduced stress, since CHI and PIN navigators handle much of the coordination and follow up.

How CHI and PIN Work Together

Some patients qualify for both CHI and PIN. This combination provides comprehensive support by addressing social barriers to care and the medical complexities of serious illness.

Example:
A cancer patient who also struggles with transportation and food insecurity could receive:

• PIN services for cancer treatment coordination
• CHI services for transportation to chemo appointments and access to nutrition programs

This dual approach maximizes care and support.

Real World Scenarios

Scenario 1: Managing chronic heart failure with CHI

Maria lives alone and struggles to get to her doctor’s appointments due to mobility issues. CHI helps her arrange wheelchair accessible transportation and connects her to a meal delivery program, which supports her low sodium diet. With these supports in place, she keeps appointments and follows her care plan.

Scenario 2: Cancer treatment with PIN

James is undergoing chemotherapy for lymphoma. His PIN navigator coordinates appointments between oncology, radiology, and primary care. The navigator also arranges home health check ins to monitor side effects. With a single point of contact, James stays on track with complex treatments.

How to Enroll in CHI or PIN

An advocate can help you take the next steps:

• Confirm eligibility for CHI, PIN, or both
• Coordinate with your healthcare provider to start services
• Complete enrollment paperwork quickly and accurately
• Connect you to the right resources immediately after approval

You can call Understood Care or request an appointment online using the resource in the References section.

Medicare CHI and PIN: Frequently Asked Questions

• What are Community Health Integration (CHI) and Principal Illness Navigation (PIN)?
  CHI and PIN are Medicare covered services that support you beyond regular office visits. Community Health Integration focuses on nonmedical issues that make it hard to follow your care plan, such as transportation, housing, or access to food. Principal Illness Navigation focuses on helping people with serious, high risk conditions, such as cancer or advanced heart failure, understand their condition, follow complex treatment plans, and stay connected with their care team.
• How is CHI different from PIN?
  CHI is centered on social and practical barriers to care. It aims to fix problems like missed rides, unsafe living conditions, food insecurity, or difficulty using patient portals, so that you can follow your clinician’s recommendations. PIN is centered on the medical side of a serious illness. It focuses on explaining diagnoses and treatments, coordinating multiple specialists, organizing appointments and tests, and helping you and your caregiver manage a complicated plan of care. Some people use only one program, while others benefit from both.
• Who might benefit from Community Health Integration (CHI)?
  You may benefit from CHI if nonmedical problems are getting in the way of your care. Examples include difficulty getting to appointments, trouble accessing healthy food, unstable or unsafe housing, not having needed medical equipment at home, or feeling isolated without support. CHI is designed for Medicare patients whose social and practical needs make it hard for their clinician to diagnose or treat them effectively. By solving these practical issues, CHI helps your medical care actually work in daily life.
• Who might benefit from Principal Illness Navigation (PIN)?
  PIN is intended for Medicare patients with serious, high risk conditions that require frequent care or close monitoring. People with cancer, congestive heart failure, COPD, dementia, serious mental health conditions, HIV, or substance use disorder are common examples. If you have a complex treatment schedule, see several specialists, or are at risk for hospitalization or decline, PIN can help you understand your plan, keep appointments organized, and stay connected to the right services.
• What kinds of help can CHI provide?
  In CHI, your team looks at how your living situation affects your care. They may help arrange rides for appointments, connect you to housing or utility assistance programs, locate food pantries or meal delivery, or help you obtain equipment like a blood pressure cuff or walker if it is part of your care plan. CHI staff also support you in using tools like patient portals or phone visits so you can stay in touch with your clinicians.
• What kinds of help can PIN provide?
  In PIN, your navigator focuses on your serious illness and the medical services around it. They can help coordinate visits between specialists, explain test results in plain language, prepare you for upcoming procedures, and help you ask clear questions at appointments. They may connect you to rehabilitation programs, mental health support, home health nursing, or caregiver resources that specifically support your treatment plan.
• How do CHI and PIN improve care coordination?
  Both programs are designed to reduce the confusion that can happen when you see several clinicians. In CHI, coordination means aligning medical care with community services, such as matching appointments with available transportation or making sure you have enough food to follow your diet plan. In PIN, coordination means making sure your specialists and primary care clinician share information and agree on a clear plan. This helps prevent missed tests, duplicated medicines, and conflicting instructions.
• Can CHI and PIN lower my chances of going to the hospital?
  Yes. By addressing problems early, both services can decrease avoidable emergency visits and hospital stays. For example, if CHI helps you get to regular checkups and keep your medications and food stable, your condition is less likely to flare. If PIN helps you follow a complicated cancer or heart failure plan, you are more likely to catch warning signs early and adjust treatment before a crisis develops.
• Can I receive both CHI and PIN at the same time?
  Some patients qualify for both services. When that happens, CHI focuses on solving the social and practical barriers around your care, while PIN focuses on navigating the serious condition itself. For example, a person receiving chemotherapy could use PIN to coordinate cancer treatment and CHI to secure rides to infusions and access nutrition support. Your practitioner will decide whether you qualify for one or both services and will structure them so that they work together.
• How do these programs affect caregivers and family members?
  CHI and PIN can reduce the burden on caregivers by taking on much of the coordination work. Navigators can help track appointments, arrange services, and communicate with clinicians, which leaves family members with more time and energy to provide emotional and practical support. In PIN especially, navigators often teach caregivers what to watch for, how to prepare for visits, and how to support the treatment plan at home.
• How do I know if I qualify for CHI, PIN, or both?
  Eligibility depends on your health conditions and the types of challenges you face. For CHI, your clinician must identify nonmedical needs that significantly interfere with your ability to follow care recommendations. For PIN, your clinician must document that you have a serious, high risk condition that needs ongoing navigation support. An advocate or care coordinator can review your situation, discuss your diagnoses and daily barriers, and help your practitioner determine whether you qualify.
• How do I enroll in CHI or PIN?
  Enrollment usually starts with a conversation with your clinician or an advocate. They will confirm whether you qualify, obtain your consent, and complete any required Medicare steps. This may include an initiating visit with your practitioner, where your medical needs and barriers are documented. After that, your navigator or CHI team will contact you regularly, usually by phone or video, to provide ongoing support. Understood Care can help you through these steps and connect you with the appropriate program.
• Will CHI or PIN replace my regular doctor or specialist?
  No. CHI and PIN are meant to support your existing clinicians, not replace them. Your primary care provider and specialists still make medical decisions, prescribe medicines, and order tests. CHI and PIN staff help you understand and carry out those plans, communicate concerns to your clinicians, and close the gaps between visits.
• What is the role of an advocate in CHI or PIN at Understood Care?
  At Understood Care, advocates and clinicians work together to provide CHI and PIN services. They help you confirm eligibility, explain how the programs work, prepare questions for visits, organize your medication list and schedule, and coordinate communication with your care team. They can also help you complete enrollment forms, connect you to transportation or housing resources, and follow up after appointments to be sure next steps actually happen.
• How can I get help deciding if CHI or PIN is right for me?
  If you are not sure whether you qualify, you can speak with an advocate or your clinician and describe your diagnosis, current challenges, and recent hospital or emergency visits. They can compare your situation to Medicare’s criteria for CHI and PIN and suggest the best option. You can also review the detailed CHI and PIN guides listed in the References section of the article that this FAQ is based on, or contact Understood Care directly for personalized guidance.

References

External Sources

• Medicare – Community Health Integration Services https://www.medicare.gov/coverage/community-health-integration-services
• Medicare – Principal Illness Navigation Services https://www.medicare.gov/coverage/principal-illness-navigation-services
• Rural Health Information Hub – Principal Illness Navigation Services https://www.ruralhealthinfo.org/care-management/principal-illness-navigation-services

This content is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for personalized care.‍