Florida Patient Advocates, 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 Florida members pay $0. We confirm exactly what your coverage looks like before your first session, and there are no surprise bills.

Yes, all 67 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Miami, Jacksonville, Tampa, Orlando, Fort Lauderdale, Fort Myers, Sarasota, The Villages, Pensacola, and every county in between. 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 Florida's programs like SHINE, the Medicare Savings Programs, the Statewide Medicaid Managed Care Long-Term Care waiver, and PACE, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Not on your own timeline. Your one guaranteed six-month Medigap Open Enrollment Period begins the first month you are both 65 or older and enrolled in Part B, and it does not repeat. Florida has no birthday rule and no year-round switching window, so after that window insurers can medically underwrite you. Where Florida goes beyond the federal floor is for people who came onto Medicare early: state law (Fla. Stat. 627.6741) requires every insurer that sells Medigap in Florida to offer a policy to beneficiaries under 65 who qualify through disability or end-stage renal disease, with a six-month guaranteed-issue window of their own. Because everything here turns on timing, this is exactly where an advocate helps.

Those are Florida Medicaid programs. The Statewide Medicaid Managed Care Long-Term Care program has a Participant Direction Option (PDO) that lets you direct your own care and hire providers you choose, and in Florida a spouse or other family member can be paid through it when the plan approves the arrangement. PACE bundles Medicare and Medicaid care for dual-eligible adults 55 and older near a provider site. 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 waiver caregiving, and your parent's advocate handles the Medicare paperwork.

SHINE, Serving Health Insurance Needs of Elders (1-800-963-5337), is Florida's free Medicare counseling service, run by the Florida Department of Elder Affairs with trained, commission-free volunteers hosted by 11 Area Agencies on Aging across all 67 counties, and it is excellent for one-off questions. 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 SHINE counselors for enrollment-season plan comparisons.