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

Yes, all 24 jurisdictions: Maryland's 23 counties plus Baltimore City. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same across the Baltimore metro and Central Maryland as it does in the Capital Region suburbs of Montgomery and Prince George's counties, Southern Maryland, Frederick and Western Maryland, and the Eastern Shore. 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 Maryland's programs and rules: the Medigap birthday rule (a 30-day window each year, starting on your birthday, to switch to an equal-or-lesser-benefit plan with no medical underwriting), the state's guaranteed-issue Medigap right for under-65 disabled beneficiaries, SHIP counseling (free Medicare counseling from the Maryland Department of Aging), the Medicare Savings Programs the Maryland Department of Health runs, the SPDAP drug-premium subsidy, and the paid-family-caregiving path (Community First Choice, where a family member can be hired to provide personal care), and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Maryland is one of a handful of states with a birthday rule, and it took effect July 1, 2023. Each year, for the 30 days starting on your birthday, you can switch to a Medicare Supplement (Medigap) plan with the same or fewer benefits, offered by any insurer selling Medigap in Maryland, with no medical underwriting: your application cannot be denied or priced up because of your health or claims history (regulated by the Maryland Insurance Administration). The one limit is direction: you can move to an equal-or-lesser-benefit plan, not use the window to jump up into a richer plan, so 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. In practice the birthday rule is most valuable for shopping the same plan letter, say Plan G, across carriers for a lower premium. Maryland also goes further than most states for younger beneficiaries: if an insurer sells Plan A to people 65 and older, it must offer Plan A to people under 65 who have Medicare because of a disability, guaranteed-issue within six months of enrolling in Part B, at no more than the average 65-and-older Plan A premium. Knowing which move keeps your guaranteed-issue rights is exactly where an advocate helps.

Those run through Maryland Medical Assistance (Maryland Medicaid, administered by the Maryland Department of Health) rather than Medicare. Maryland delivers Medicaid personal care through Community First Choice, a state-plan entitlement with no waitlist for people who need a nursing-facility level of care, along with the Community Options waiver and Community Personal Assistance Services. Community First Choice includes a self-directed option: an eligible person can hire and direct their own caregiver, and in Maryland that caregiver can be a family member such as an adult child. The paid caregiver cannot be the participant's legal guardian or authorized representative, and hours are set through a functional assessment. 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 State Health Insurance Assistance Program, Maryland's free Medicare counseling, reachable at 1-800-243-3425) is delivered through the Maryland Department of Aging with trained, commission-free volunteer 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 Maryland we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~26% of Maryland MA members); Humana Medicare Advantage plans (~20% of Maryland MA members); Aetna Medicare Advantage plans (~12% of Maryland MA members). Together that covers roughly 88.7% of Maryland's Medicare beneficiaries. Market-share data: 2023. Plan networks change, so we confirm exactly what your plan covers before any work begins - no surprise bills.