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

Yes, all 102 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Chicago and the collar counties as it does in Rockford, the Quad Cities, Peoria, Bloomington-Normal, Springfield, Champaign-Urbana, and the Metro East. 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 Illinois's programs and rules, the state's Medigap timing (Illinois added a birthday rule in 2025, so people 65 to 75 who already have a Medigap policy get a 45-day window each year, starting on their birthday, to switch to an equal-or-lesser plan with their own insurer or an affiliate without underwriting) and its under-65 disability Medigap protection, SHIP counseling (Illinois's free Senior Health Insurance Program), the Medicare Savings Programs the Department of Healthcare and Family Services runs with an income and asset test, and the paid-family-caregiving path (the Home Services Program, plus the Community Care Program for seniors 60 and older), and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Not any time, but Illinois is more flexible than it used to be. Effective 2025, Illinois added a Medigap birthday rule: if you are 65 to 75 and already hold a Medicare Supplement policy, you get a 45-day window each year, starting on your birthday, to move to a plan with equal or lesser benefits with your current insurer or one of its affiliates, with no medical underwriting. Your first and widest opportunity is still the one-time federal six-month Medigap Open Enrollment Period that starts when you are 65 and enrolled in Part B; outside the birthday window and that first enrollment, insurers can medically underwrite you when you apply for richer coverage or switch carriers, except in a few federal guaranteed-issue situations. Illinois also protects younger beneficiaries: every Medigap insurer must offer at least one plan on a guaranteed-issue basis to people under 65 who have Medicare because of a disability, though the premium can be as high as the top rate the insurer charges its 65-and-older enrollees. Knowing which window you are in, and when underwriting applies, is exactly where an advocate helps.

Those run through Illinois Medicaid (administered by HFS) rather than Medicare. Illinois's Home Services Program, run by the Department of Human Services, is consumer-directed: an eligible person can hire and direct their own caregiver, and that caregiver can be a family member, though not a spouse. For seniors 60 and older, the Community Care Program (run by the Department on Aging) covers homemaker and adult-day services, but it does not pay a family member directly. 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 the Medicaid paperwork, and your parent's advocate handles the Medicare paperwork.

SHIP (the Senior Health Insurance Program, Illinois's free Medicare counseling, reachable on the Senior HelpLine at 1-800-252-8966) is delivered through the Illinois Department on Aging, through the state's 13 Area Agencies on Aging with trained, commission-free counselors, 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 SHIP counselors for enrollment-season plan comparisons.

In Illinois we are in-network for Original Medicare (traditional fee-for-service Medicare); Aetna Medicare Advantage plans (~31% of Illinois MA members); UnitedHealthcare Medicare Advantage plans (~21% of Illinois MA members); Blue Cross and Blue Shield of Illinois (HCSC) Medicare Advantage plans (~5% of Illinois MA members). Together that covers roughly 79.6% of Illinois's Medicare beneficiaries. Market-share data: 2025. Plan networks change, so we confirm exactly what your plan covers before any work begins - no surprise bills.