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

Yes, all 14 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Burlington, Rutland, Montpelier, and Brattleboro as it does in the hill towns of the Northeast Kingdom and the villages along the Connecticut River. Where the nearest specialist is a long winter drive 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 Vermont's programs like free SHIP counseling through the Area Agencies on Aging, the Medicare Savings Programs DVHA runs with no resource limit, and Choices for Care, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Usually not. Vermont has no Medigap birthday rule or other yearly switching window (a 2025 bill to create an annual open enrollment, H.275, was not enacted), so outside your six-month Medigap open enrollment after Part B starts and the federal guaranteed issue rights (for example, when a Medicare Advantage plan leaves your area or you lose employer retiree coverage), insurers can use medical underwriting. Vermont does require community rating, so your premium is not based on your age. Questions and complaints go to the Vermont Department of Financial Regulation at 1-800-964-1784.

Yes, if you are on Medicare because of a disability. Vermont law requires every insurer that sells Medigap to people 65 and older to make the same policies available to people on Medicare because of a disability. Insurers may set a separate community rate for the under-65 group, and when you turn 65 the insurer must move you to its 65-and-older rate. A free SHIP counselor at 1-800-642-5119 can walk you through the options, including Medicare Advantage.

Yes, and Vermont's rules are specific. The main Medicaid path to long-term care at home is Choices for Care, for Vermonters 18 and older who need a nursing home level of care, with a smaller Moderate Needs group for lighter help. At home you can use an agency, hire your own caregivers through the consumer- or surrogate-directed option, or manage a budget through Flexible Choices, with a case manager from your local Area Agency on Aging. A spouse or civil union partner cannot be paid for household tasks, respite, or companion care, and a court-appointed guardian cannot be paid at all. The Department of Vermont Health Access decides financial eligibility on the long-term care application (request one at 1-833-840-0061); for help applying, call the Senior HelpLine at 1-800-642-5119. Vermont has no PACE program. 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.

Vermont's State Health Insurance Assistance Program (SHIP), reachable at 1-800-642-5119, offers free, unbiased Medicare counseling through Vermont's five Area Agencies on Aging, 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 Vermont we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~15% of Vermont MA members); Humana Medicare Advantage plans (<1% of Vermont MA members). Together that covers roughly 63.5% of Vermont'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.