Do You Qualify for Medicare’s Community Health Integration or Principal Illness Navigation Programs?

Introduction

If you’re a Medicare patient living with a chronic or serious condition, you may qualify for extra support through Medicare’s Community Health Integration (CHI) or Principal Illness Navigation (PIN) programs. These programs are designed to help you manage care more effectively, address barriers to treatment, and connect with vital Medicare patient support services.

In this guide, we explain Medicare CHI eligibility, Principal Illness Navigation program benefits, and how Understood Care can make the enrollment process simple.

What is Medicare’s Community Health Integration (CHI)?

Community Health Integration is a Medicare-covered program for patients who face non-medical challenges that impact their ability to get proper treatment.

You may qualify for CHI if you have:

• Transportation challenges preventing you from attending appointments or picking up prescriptions.
• Food insecurity with limited access to healthy meals.
• Housing insecurity or unsafe living conditions.
• Social isolation or lack of supportive connections.
• Unmet medical equipment needs like wheelchairs, walkers, oxygen, or other devices.

By meeting Medicare CHI eligibility requirements, patients can access care coordination services and be connected to community resources that improve health outcomes.

What is Medicare’s Principal Illness Navigation (PIN)?

The Principal Illness Navigation program is for Medicare patients with one or more serious health or psychiatric conditions lasting at least three months, putting them at high risk of hospitalization, nursing home admission, or rapid health decline.

You may qualify for the Medicare PIN program if:

• You have difficulty with daily activities such as bathing, dressing, or cooking, or have experienced falls.
• You’ve had ER visits or hospital stays due to your condition.
• Your health worsens suddenly without warning.
• You have frequent doctor visits or testing needs that are hard to coordinate.
• Your treatment plan is complex or confusing.
• A provider has recommended nursing home or rehab care.

Medication-based qualifications may include high-risk prescriptions that require frequent monitoring, cause strong side effects, or carry a higher risk profile — such as blood thinners (Coumadin, Plavix, Eliquis), chemotherapy, epilepsy medications, or opioids.

Benefits of Medicare’s CHI and PIN Programs

Both programs give Medicare patients:

• Personalized care coordination to simplify treatment.
• Resource connections to address both medical and non-medical needs.
• Reduced stress when navigating the healthcare system.
• Improved health outcomes through consistent and proactive support.

How Understood Care Helps with CHI and PIN Enrollment

At Understood Care, our advocates specialize in helping Medicare patients determine if they qualify for CHI or PIN. We:

• Confirm your eligibility for Medicare CHI or the Principal Illness Navigation program.
• Handle enrollment paperwork and requirements.
• Coordinate between healthcare providers and community resources.
• Ensure you receive every benefit available to you under Medicare coverage.

How to Prepare for Your Appointment

To make the most of your intake appointment for CHI or PIN:

• Bring your complete medical history.
• List all current medications, especially those that may qualify you for PIN.
• Be ready to discuss any social or daily life challenges affecting your care.

About the Author

Adam J. Bonder, MD, MBA – Medical Director
Dr. Adam J. Bonder is the Medical Director at Understood Care, where he leads programs focused on Medicare patient support services. With expertise in clinical medicine and healthcare management, Dr. Bonder works to remove barriers to care and help patients get the most from their Medicare benefits, including CHI and PIN programs.

FAQ: Medicare CHI and PIN

• Are Medicare CHI and PIN programs covered?
  Yes. Both programs are covered for eligible patients under Medicare.
• Can I qualify for both programs?
  It depends on your needs and Medicare guidelines. An Understood Care advocate can help you determine the best fit.
• Do I need a referral to enroll?
  Not necessarily. Your provider or an Understood Care advocate can confirm eligibility and start enrollment.