What “expert help” means for you
When your health gets complicated, having a dedicated guide can make the difference between feeling lost and feeling in control. Patient advocates help you understand your diagnosis and treatment plan, coordinate appointments, organize medications, and connect you with community resources. Research shows that patient navigation and coordinated care improve access to treatment, reduce delays, and support better outcomes, especially for people with chronic or serious conditions and for caregivers supporting a loved one [see References].
New Medicare-covered services that enable advocacy
As of January 1, 2024, Medicare created and pays for two care management services that formalize and fund this kind of hands-on help:
- Principal Illness Navigation (PIN). Ongoing navigation for people living with a serious, high-risk condition that is expected to last at least three months. PIN focuses on education, barrier-reduction, and helping you follow a disease-specific care plan.
- Community Health Integration (CHI). Personalized help addressing unmet social needs that get in the way of medical care, such as transportation, food access, housing stability, or health literacy. The goal is to remove practical barriers so your treatment plan can succeed.
Medicare’s own pages and rule summaries confirm that PIN and CHI became payable beginning in 2024, are delivered under the supervision of your clinician, and require an initiating visit with the practitioner who will bill for services. That initiating visit is a standard evaluation and management visit or similar covered service. It can be furnished by phone or video when Medicare telehealth rules allow, but it is not the same as an email or text message.
How our process works, step by step
This section draws directly from the video script so you know exactly what to expect.
1) Start the conversation
You can begin in two ways:
- Fill out a simple form to request a visit and scheduling support.
Visit the Understood Care home page and select Get Started to access the intake form. - Ask a general question by phone. If you are unsure whether you need an advocate, you can call to ask questions. If the intake team cannot answer, they will connect you with someone who can. We can answer questions and help you be your own advocate. We do not give medical diagnosis or prescribe care over the phone, but we can explain options and next steps.
2) Meet briefly with a provider
If you feel you need a dedicated advocate, your journey begins with a 20 to 30 minute visit with one of our providers. During this visit, the clinician reviews your health history as it relates to the support you are seeking and confirms whether PIN or CHI is appropriate. This visit serves as the initiating visit required by Medicare for PIN or CHI services.
- Per Medicare guidance, the initial visit must be a real clinical encounter.
- It must occur by phone or video for the first visit. Medicare does not consider email or text alone to be an initiating clinical visit.
3) Get matched with your dedicated patient advocate
After your provider visit, you are assigned a dedicated patient advocate. That person remains your point of contact for as long as you are an Understood Care patient. Your advocate coordinates closely with our clinical team so that your questions, goals, and day-to-day needs are understood and addressed.
4) Stay connected virtually
Both the visit with the provider and the first visit with your advocate are conducted by phone or video. Ongoing support also happens virtually so that you can access help from home, even if travel is difficult.
What a patient advocate actually does
Your advocate is your guide and problem-solver. Typical ways we help:
- Care coordination: scheduling and tracking appointments, sharing information between your doctors, and preparing you for visits so your questions get answered.
- Treatment plan support: explaining diagnoses and instructions in plain language, helping you follow the care plan your clinician has set.
- Medication organization: clarifying refills and timing, and identifying common barriers that cause missed doses.
- Community connections: arranging transportation, home safety equipment, meal support, and other services that keep you well at home.
- Caregiver support: helping family members understand the plan, organize tasks, and find respite resources.
- Insurance navigation: answering Medicare questions, helping with claims or denials, and reducing paperwork stress.
These activities align with how Medicare defines the elements of PIN and CHI and are supported by strong evidence from peer-reviewed studies and national agencies.
Is this covered by Medicare?
- Yes, for most people with Medicare Part B. Medicare pays for PIN and CHI when eligibility criteria are met and the required initiating visit has taken place.
- You may have a copay. Standard Part B cost sharing can apply. Your advocate can help you understand potential costs before you begin.
- Only one clinician bills per month per service. Medicare rules prevent duplicate billing for the same service in the same month, which keeps your care coordinated.
Why Medicare requires an initiating visit
The initiating visit verifies that:
- You have a qualifying serious condition for PIN or an unmet social need interfering with care for CHI.
- A responsible practitioner is supervising the service and has set or confirmed your plan of care.
- Consent is obtained and documented. For PIN and CHI, Medicare allows consent to be written or verbal as long as it is recorded in your medical record.
Because it is a clinical service, the initiating visit must be a billable encounter with your practitioner and cannot be performed solely through email or text messages. Under current Medicare telehealth flexibilities, many initiating visits may occur by phone or video when applicable.
What you will notice day to day
Shorter to-do lists. We take on coordination so you can spend your time on healing, not phone trees.
Fewer delays. Navigation reduces common barriers that stall care, like missing records, transportation gaps, or confusion about instructions.
More confidence and clarity. Advocates prepare you for visits, help you ask the right questions, and translate medical language into plain words.
Support for your caregiver. Family and friends get tools and guidance so you do not have to carry everything alone.
How to get started today
Safety, privacy, and respect
Understood Care follows HIPAA safeguards to protect your information. Your advocate and clinicians coordinate with your permission, and your plan of care is documented so everyone on your team is working from the same page. Medicare rules also require annual consent for PIN and CHI to ensure you remain comfortable with services.
Tips to get the most from your advocate
- Bring your priorities. Write down your top two or three goals for the next month.
- Prepare for visits. Keep a short list of questions and any new symptoms or barriers.
- Create a shared calendar. Ask your advocate to help set reminders for appointments and refills.
- Loop in your caregiver. Invite the person who helps you at home to join phone or video visits.
- Speak up. If something is not working, say so. Your plan should be updated to fit your life.
Cross-references within Understood Care
References
- Centers for Medicare & Medicaid Services. Health-Related Social Needs FAQ. Answers questions about Principal Illness Navigation, Community Health Integration, caregiver training, and SDOH risk assessment, including initiating visit requirements, consent, supervision, and billing.
https://www.cms.gov/files/document/health-related-social-needs-faq.pdf - Medicare.gov. Principal illness navigation services. Consumer-facing description of what PIN covers, who is eligible, and basic cost information under Part B.
https://www.medicare.gov/coverage/principal-illness-navigation-services - Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule Final Rule Summary: CY 2024. Confirms that new HCPCS codes for Principal Illness Navigation and related services are payable beginning in 2024.
https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf - U.S. Department of Health and Human Services. Telehealth policy updates. Summarizes time-limited Medicare telehealth flexibilities, including allowance for certain audio-only services through September 30, 2025.
https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates - Centers for Disease Control and Prevention. Patient Navigation. Overview of patient navigation programs and core functions used by health systems and community partners.
https://www.cdc.gov/cancer/php/interventions/patient-navigation.html - Agency for Healthcare Research and Quality. Care Coordination in Primary Care. Defines care coordination and goals for safer, more effective, patient-centered care.
https://www.ahrq.gov/ncepcr/care/coordination.html - President’s Cancer Panel, National Cancer Institute. Enhancing Patient Navigation with Technology to Improve Equity in Cancer Care. Federal report identifying priorities for navigation to improve access and outcomes.
https://prescancerpanel.cancer.gov/reports-meetings/enhancing-patient-navigation-2024 - BMC Health Services Research. Evaluating implementation of a community-focused patient navigation program. Peer-reviewed study on navigation design and outcomes.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10919-y - Springer Current Oncology Reports. Patient Navigation in Cancer Treatment: A Systematic Review. Synthesis of evidence that navigation improves access and treatment outcomes, particularly in underserved populations.
https://link.springer.com/article/10.1007/s11912-024-01514-9 - AHRQ. Patient-Centered Medical Home resources. Background on team-based, coordinated models that underpin advocacy-supported care.
https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/index.html
This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.
