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

Yes, all 21 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Newark, Jersey City, Paterson, Elizabeth, Edison, Trenton, Toms River, and down the Shore and across South Jersey. 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 New Jersey's programs and rules, the state's federal Medigap timing (New Jersey has no birthday rule, so getting the one-time window right at 65 matters) and its strong under-65 disability Medigap protection, SHIP counseling (New Jersey's free Medicare counseling), the PAAD and Senior Gold state drug programs, the Medicare Savings Programs the Division of Aging Services runs with an income and asset test, and the paid-family-caregiving path (the Personal Preference Program under MLTSS), and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Not freely, and this is exactly where New Jerseyans get caught. New Jersey has no Medigap birthday rule and no annual guaranteed-issue window for people 65 and older, so it follows the federal rules: your one guaranteed six-month Medigap Open Enrollment Period starts when you are 65 and enrolled in Part B, and after it closes an insurer can use medical underwriting to raise your rate or turn you down (outside a few narrow federal guaranteed-issue situations). New Jersey does add a protection many states lack for younger beneficiaries: at least one carrier must offer a Medigap plan on a guaranteed-issue basis to people under 65 who have Medicare because of a disability or ESRD, at the same premium it charges a 65-year-old, if they apply within 12 months of enrolling in Part B. Timing that one-time window at 65, and knowing when underwriting applies, is precisely where an advocate helps.

Those run through NJ FamilyCare (New Jersey's Medicaid) rather than Medicare. New Jersey delivers Medicaid long-term care through Managed Long Term Services and Supports (MLTSS), and its self-directed Personal Preference Program can pay a family caregiver, including a spouse, directly to provide personal care so a person can stay home. 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, New Jersey's free Medicare counseling, reachable at 1-800-792-8820) is delivered through the New Jersey Department of Human Services, Division of Aging Services, through the County Offices 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 New Jersey we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~27% of New Jersey MA members); Aetna Medicare Advantage plans (~15% of New Jersey MA members); New Jersey Blue Cross Blue Shield Medicare Advantage plans (~8% of New Jersey MA members). Together that covers roughly 79% of New Jersey's Medicare beneficiaries. Market-share data: 2025-2026. Plan networks change, so we confirm exactly what your plan covers before any work begins - no surprise bills.