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

Yes, all 95 counties and all 38 independent cities. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Northern Virginia and Hampton Roads as it does in Richmond, the Shenandoah Valley, Charlottesville and Lynchburg, Roanoke and the New River Valley, and Southwest Virginia. 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 Virginia's programs and rules, the state's Medigap timing (Virginia added a birthday rule effective July 1, 2025, so anyone who already holds a Medicare Supplement policy gets a 60-day window each year, starting on their birthday, to switch to a same-benefit-level plan from any insurer in Virginia without underwriting) and its under-65 disability Medigap protection (offered at the same premium a 65-year-old pays, and since 2024 extended to people with ESRD), VICAP counseling (Virginia's free Medicare counseling), the Medicare Savings Programs the Department of Medical Assistance Services runs with an income and asset test, and the paid-family-caregiving path (the Commonwealth Coordinated Care Plus Waiver under Cardinal Care), and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Not any time, but Virginia is more flexible than it used to be. Effective July 1, 2025, Virginia added a Medigap birthday rule: if you already hold a Medicare Supplement policy, you get a 60-day window each year, starting on your birthday, to move to a Medigap plan with the same level of benefits offered by any insurer in Virginia, with no medical underwriting, and your insurer must notify you 15 to 30 days before it opens. 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; outside the birthday window and that first enrollment, insurers can medically underwrite you when you apply for richer coverage or switch to a different benefit level, except in a few federal guaranteed-issue situations. Virginia also protects younger beneficiaries: every Medigap insurer must offer at least one plan on a guaranteed-issue basis to people under 65 who have Medicare because of a disability, at a premium no higher than the rate charged to a 65-year-old, and since 2024 that right also covers people with end-stage renal disease. Knowing which window you are in, and when underwriting applies, is exactly where an advocate helps.

Those run through Cardinal Care (Virginia Medicaid, administered by DMAS) rather than Medicare. Virginia's Commonwealth Coordinated Care Plus Waiver offers consumer-directed personal care: an eligible person can hire and direct their own attendant, and that attendant can be an adult child or another relative. Since July 1, 2025, a legally responsible individual (a spouse, or the parent of a minor) may also be paid, but only for 'extraordinary' care beyond what they already owe, and capped at 40 hours a week. For seniors and people with disabilities, this pathway requires ABD Medicaid eligibility and a nursing-facility level-of-care screening. 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.

VICAP (the Virginia Insurance Counseling and Assistance Program, Virginia's free Medicare counseling, reachable on the statewide 1-800-AGE-LINE at 1-800-243-5463) is delivered through the Virginia Department for Aging and Rehabilitative Services (DARS), through local Area Agencies 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 VICAP counselors for enrollment-season plan comparisons.

In Virginia we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~25% of Virginia MA members); Aetna Medicare Advantage plans (~12% of Virginia MA members). Together that covers roughly 75.1% of Virginia'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.