Patient Advocate Services in Delaware, Covered by Medicare

Yes. Since January 2024, Medicare pays for professional healthcare navigation through Principal Illness Navigation and Community Health Integration services. Medicare Part B covers about 80% of the cost, and a supplemental (Medigap) plan typically covers the rest, so most Delaware members pay $0. We confirm exactly what your coverage looks like before your first session, and there are no surprise bills.

Yes, all three counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Wilmington, Newark, Dover, Middletown, Bear, Milford, Seaford, Georgetown, Lewes, and every town in New Castle, Kent, and Sussex. There is no office to travel to.

Advocates work virtually and are matched to you, not to a zip code. What matters is that your advocate is the same person every time (One Advocate, For Life), knows Delaware's programs like DMAB counseling from the Delaware Department of Insurance, the Medicare Savings Programs the DMMA runs with no asset test, the Delaware Prescription Assistance Program (DPAP), and the Diamond State Health Plan-Plus long-term-care program, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Yes, and Delaware is better than most states here. Federal law does not guarantee Medigap to people who qualify for Medicare under 65 through disability, but Delaware's Senate Bill 42 (2013) requires every insurer that sells Medicare Supplement policies to also offer them to under-65 disability beneficiaries, with a six-month guaranteed-issue window. Insurers are allowed to charge under-65 enrollees a higher premium (and more for ESRD), so the price can be steep, but the right to buy is protected. When you turn 65, a fresh six-month Medigap Open Enrollment Period opens for every plan at standard rates. Timing those windows is where an advocate helps most.

Yes, as of January 1, 2026. Delaware's Senate Bill 71 created a Medigap birthday rule: each year, existing supplement policyholders get a window that starts 30 days before their birthday and runs at least 30 days after, during which they can switch to a plan with equal or lesser benefits with no medical underwriting and no health questions. It joins a small group of states (California, Oregon, Maryland, and a few others) with this protection. Outside that window, and for a first purchase, the key guaranteed period is still the six-month Open Enrollment that starts at 65 with Part B. Tracking your birthday window each year is exactly the kind of deadline an advocate watches for you.

Those are Delaware Medicaid long-term-care programs. Diamond State Health Plan-Plus (DSHP-Plus) is Delaware's managed long-term services and supports program: its Long Term Care Community Services track helps people who meet a nursing-facility level of care get personal care, adult day services, home-delivered meals, personal emergency response, and respite so they can stay home instead of entering a facility. Unlike a capped waiver, DSHP-Plus is an entitlement, so there is no waiting list. Its self-direction option lets the person receiving care hire and pay the caregiver they choose, including a family member such as an adult child, with a financial management service handling payroll and taxes. Delaware also has PACE (PACE Your LIFE) for adults 55 and older at a nursing-facility level of care, but only in Kent and Sussex counties. Contact DSAAPD at 302-255-9390 or the DMMA to start. Our advocacy is billed through Medicare, so we focus on the Medicare side: bills, appeals, appointments, coverage questions. For dual-eligible families that split works well: you manage the caregiving, and your parent's advocate handles the Medicare paperwork.

The Delaware Medicare Assistance Bureau (DMAB, reachable at 1-800-336-9500) is Delaware's free Medicare counseling service, run by the Delaware Department of Insurance with trained, commission-free counselors, and it is excellent for one-off questions like comparing plans during Open Enrollment. Understood Care is different: a dedicated advocate who does the work itself, makes the calls, files the appeals, untangles the bills, and stays with you month after month, covered by Medicare. The two are complementary, and we often point our own members to DMAB counselors for enrollment-season plan comparisons.

In Delaware we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~37% of Delaware MA members); Aetna Medicare Advantage plans (~12% of Delaware MA members). Together that covers roughly 83.7% of Delaware's Medicare beneficiaries. Market-share data: 2024. Plan networks change, so we confirm exactly what your plan covers before any work begins - no surprise bills.