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

Yes, all 39 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same across the Puget Sound metros (Seattle, Bellevue, Tacoma, Everett) as it does in Spokane and the Inland Northwest, the Tri-Cities, Yakima and Central Washington, the Olympic and Kitsap peninsulas, Bellingham and the North Sound, and Southwest Washington around Vancouver. 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 Washington's programs and rules: the state's unusually flexible Medigap switching (Washington lets anyone who has held a Medicare Supplement policy for at least 90 days move to a plan with equal or lesser benefits at any time of year, from any insurer, with no medical underwriting), SHIBA counseling (Washington's free Medicare counseling from the Office of the Insurance Commissioner), the Medicare Savings Programs the Health Care Authority runs with an income test and no asset test, and the paid-family-caregiving path (Apple Health's COPES waiver and Community First Choice, where an adult child or relative can be hired as an Individual Provider), and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Washington is one of the most flexible states in the country for this. Once you have held a Medicare Supplement (Medigap) policy for at least 90 days, you can switch to a plan with the same or fewer benefits at any time of year, offered by any insurer selling Medigap in Washington, with no medical underwriting (RCW 48.66.045). There is no birthday rule and no once-a-year window: it is continuous. The one limit is the direction of the move, you can switch to an equal-or-lesser-benefit plan but not use this right to jump up into a richer plan; your first and widest opportunity for any plan is still the one-time federal six-month Medigap Open Enrollment Period that starts when you are 65 and enrolled in Part B. One caveat worth knowing: unlike some states, Washington does not require insurers to offer Medigap to people under 65 who have Medicare because of a disability, so under-65 options are limited and priced higher where they exist. Knowing which move keeps your guaranteed-issue rights is exactly where an advocate helps.

Those run through Apple Health (Washington Medicaid, administered by the Health Care Authority) rather than Medicare. Washington delivers Medicaid personal care through Community First Choice and the COPES waiver: an eligible person can hire and direct their own caregiver, and that caregiver, an Individual Provider employed through Consumer Direct Care Network Washington, can be an adult child or another relative. A spouse generally cannot be paid as an Individual Provider. Getting there requires functional-eligibility and financial screening through DSHS Home and Community Services. Washington also supports unpaid family caregivers through the MAC and TSOA programs (though new enrollment in those was paused in December 2025, so check current availability). 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.

SHIBA (Statewide Health Insurance Benefits Advisors, Washington's free Medicare counseling, reachable on the OIC consumer hotline at 1-800-562-6900) is delivered through the Washington State Office of the Insurance Commissioner (OIC) with trained, commission-free volunteer advisors, 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 SHIBA advisors for enrollment-season plan comparisons.

In Washington we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~26% of Washington MA members); Wellcare Medicare Advantage plans (~4% of Washington MA members). Together that covers roughly 65.7% of Washington's Medicare beneficiaries. Market-share data: 2024. Plan networks change, so we confirm exactly what your plan covers before any work begins - no surprise bills.