Patient Advocate Services in Rhode Island, 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 5 counties: Bristol, Kent, Newport, Providence, and Washington. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Providence, Warwick, Cranston, and Pawtucket as it does in Newport, the East Bay, South County, and the rural northwest corner. When getting to an appointment means a drive into Providence, an 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 Rhode Island's rules like free SHIP counseling through the Office of Healthy Aging, the yearly fall window to switch Medigap plans, the higher income limits for the Medicare Savings Programs, RIPAE, and Medicaid home care through Personal Choice, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Once a year, yes. Every fall, during Medicare's Annual Enrollment Period (October 15 to December 7), Rhode Island law guarantees you any available Medigap policy, starting January 1, if you have had Medigap, a Medicare Advantage plan, or other credible coverage with no gap of more than 90 days since your Medigap open enrollment. Insurers cannot turn you down or use your health history during that window, and it also works as a yearly route from Medicare Advantage back to Original Medicare with a Medigap plan. Rhode Island has no birthday rule and does not community-rate Medigap: most policies are priced by your current age. Outside that window and the federal guaranteed issue rights, insurers can use medical underwriting. Questions and complaints go to the Office of the Health Insurance Commissioner (OHIC) at 401-462-9517.

Yes, Plan A, if you are on Medicare because of a disability or end-stage renal disease. Rhode Island law requires every insurer that sells Plan A to sell it to you with no medical underwriting during the first six months after you become eligible for Part B, and people under 65 with Plan A or a Medicare Advantage plan are also guaranteed Plan A during the yearly fall window. When you turn 65, you get a new six-month open enrollment for any Medigap plan. A free SHIP counselor at 1-888-884-8721 can walk you through the options, including Medicare Advantage.

Yes, and Rhode Island's rules are specific. Medicaid Long-Term Services and Supports bring in-home care to people the Department of Human Services' Clinical Team finds at a high or highest level of need. Through Personal Choice, Rhode Island's self-directed program, adults 65 and older, or 18 and older with a disability, can hire and direct their own personal care aide; the rule bars a spouse, the participant's representative, a financial power of attorney, or a Social Security representative payee from being the paid aide. Shared Living (RIte@Home) pays a caregiver who lives in the home, often a relative or friend. For people who do not qualify for Medicaid, the Office of Healthy Aging's At HOME Cost Share program helps pay for in-home help and adult day programs. And PACE Organization of Rhode Island (PACE-RI) runs an all-inclusive PACE program across the state. To start, call the Aging and Disability Resource Center at 401-462-4444, or DHS about Medicaid long-term care at 401-574-8474. 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.

Rhode Island's State Health Insurance Assistance Program (SHIP), run by the Office of Healthy Aging at 1-888-884-8721, offers free Medicare counseling through trained volunteers and community partner sites around the state, 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 Rhode Island we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~12% of Rhode Island MA members). Together that covers roughly 48% of Rhode Island's Medicare beneficiaries. Market-share data: 2024. Plan networks change, so we confirm exactly what your plan covers before any work begins.