Patient Advocate Services in Maine, 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. We check your coverage and tell you exactly what, if anything, you will owe before your first session.

Yes, all 16 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Portland, Lewiston, Bangor, and Augusta as it does on the Midcoast, Downeast, in the western mountains, and up in Aroostook County. Where the nearest specialist is hours away, a virtual advocate you can reach without the trip is often the practical option, not the fallback.

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 Maine's rules like free Maine SHIP counseling, community-rated Medigap and the right to switch to a plan with the same or fewer benefits, the Medicare Savings Programs with no asset test, and MaineCare home care, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Often, yes, and at any time of year. Maine law lets you move to a Medigap plan with the same or fewer benefits, from the same or a different insurance company, with no medical underwriting, as long as you have not gone more than 90 days without coverage that supplements Medicare since your Medigap open enrollment. Separately, every insurer must accept any applicant for Plan A during a one-month guaranteed issue period it picks each year. Maine also requires community rating, so Medigap premiums cannot vary by age or health. Questions and complaints go to the Maine Bureau of Insurance at 1-800-300-5000.

Yes, if you are on Medicare because of a disability. Maine law requires every Medigap insurer to offer its standardized plans to people on Medicare through a disability, regardless of age, during their Medigap open enrollment, and to offer Plan A during its annual guaranteed issue month. Because Maine requires community rating, your premium is not set by your age. After that, the same right to switch to a plan with equal or fewer benefits applies to you too. A free Maine SHIP counselor at 1-877-353-3771 can walk you through the options, including Medicare Advantage.

Yes, and Maine's rules are specific. MaineCare's Home and Community Benefits for the Elderly and Adults with Disabilities (Section 19) serves adults 18 and older who are on MaineCare and need a nursing-facility level of care, confirmed by an assessment from Maine's Assessing Services Agency at 1-833-525-5784. When funding runs short there is a first-come, first-served waiting list. You can hire and direct your own attendant, and adult children and other relatives can be paid. A spouse can be paid only through a personal care agency and only for extraordinary personal care, not household tasks, and a guardian or the person's representative cannot be paid as a self-directed attendant. Maine also funds Home Based Supports and Services as money allows. Maine has no PACE program. To start, call your Area Agency on Aging at 1-877-353-3771. 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.

Maine SHIP, the State Health Insurance Assistance Program, reachable at 1-877-353-3771, offers free, confidential Medicare counseling through Maine's five Area Agencies on Aging and Legal Services for Maine Elders, and it is excellent for one-off questions like comparing Part D or Medigap 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 SHIP counselors for enrollment-season plan comparisons.

In Maine we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~23% of Maine MA members); Anthem Blue Cross and Blue Shield (Elevance) Medicare Advantage plans (~5% of Maine MA members). Together that covers roughly 58.5% of Maine's Medicare beneficiaries. Market-share data: 2024. Plan networks change, so we confirm exactly what your plan covers before any work begins.