Understood Care
Coverage data 2024. Plan networks change - we confirm exactly what your plan covers before any work begins.
Kimberly Smith Care Advocate Kimberly helps patients and caregivers untangle Medicare, from a denied claim to a benefit nobody mentioned, with a check-in every week while a case is open.
Carolina Rees Care Advocate From the first call, Carolina is the same person every time: no call center, no starting over, and no surprise bills.
Michelle Rindfleisch Care Advocate Michelle works one-to-one with Medicare members on bills, denials, appointments, and benefits, and stays on the case until it is resolved.
Discover free WV SHIP counseling, Medicaid waivers, and paid family caregiver programs. Call 1-877-987-4463 today to find help paying for your care.
Across Charleston and the Kanawha Valley, care runs through Charleston Area Medical Center in Charleston, Thomas Memorial Hospital in South Charleston, and Boone Memorial Hospital in Madison, so referrals, prior authorizations, and bills pile up fast from Charleston, South Charleston, St. Albans, Dunbar, and Nitro to Hurricane, Winfield, and Madison. Understood Care is a virtual service: phone, video, and secure messaging. For Madison members that means no waiting room and no travel, whether the problem is a confusing hospital bill, a denied claim, a referral that went nowhere, or a parent in Boone County who needs someone watching their whole picture. Your advocate is the same person every time, follows up every 7 days while your case is active, and still checks in monthly after it is resolved. Many Charleston & the Kanawha Valley families also use West Virginia's Aged and Disabled Waiver and other home care programs alongside Medicare; we handle the Medicare side.
About 23.3% of Madison residents are 65+, close to West Virginia's statewide 20.7%. Medicare Advantage runs high here: 69.1% of the 5,770 beneficiaries in Boone County chose MA plans in 2025, above West Virginia's 55.3%. That means more prior authorizations, more network questions, and more denials worth appealing. About 1,240 neighbors are dual-eligible for Medicare and Medicaid, the group West Virginia's Aged and Disabled Waiver and Medicare Savings Programs reach.
Of 1 Medicare-certified homes, 1 rate 4+ CMS stars , a spread an advocate helps families navigate. Highest-rated nearby:
About 182 Madison households are a person 65+ living alone, and that is exactly who a dedicated advocate keeps from falling through the cracks. 11.4% of senior households here have no vehicle (about 48 households), which is why a fully virtual advocate, plus Medicare-covered ride benefits where plans include them, matters. Setting up home care, meal delivery, and transportation is core advocate work, covered by Medicare.
About 5.2% of Madison seniors live below the poverty line (West Virginia: 11.2%), and many more qualify for help they never claim: Extra Help with Part D costs and West Virginia's Medicare Savings Programs. Checking every one of those is standard advocate work. 50.2% of seniors here live with a disability, where equipment orders and prior authorizations pile up fastest. The federal government lists 5 primary-care shortage designations in Boone County, so appointment hunting is a real problem an advocate takes over.
Madison, West Virginia · Boone County · served virtually statewide
From CMS Care Compare. ER medians below are CMS-reported; West Virginia's statewide median is 141 minutes. Billing disputes, discharge planning, and referral follow-ups with these systems are everyday advocate work:
Since a 2026 law, West Virginia has a Medigap birthday rule: if your policy has been in force for at least 24 months, once a year you can switch to a policy with the same or lesser benefits from the same insurance company or one of its affiliates, with no health questions, in a window that opens on the first day of your birthday month and runs 60 days. People under 65 on Medicare through disability get no state Medigap open enrollment; it starts at 65 with Part B. Questions go to the West Virginia Offices of the Insurance Commissioner at 1-888-879-9842. WV SHIP, the state's free Medicare counseling program, reachable at 1-877-987-4463, gives unbiased help to Madison residents. Many Madison seniors also qualify for Extra Help and West Virginia's Medicare Savings Programs, which the Department of Human Services decides (apply through WV PATH or at 1-877-716-1212; there is an income and resource test), but never claim them. The full, sourced rundown is on our West Virginia patient advocacy hub.
West Virginia's Aged and Disabled Waiver, run by the Bureau for Medical Services, is the main path to Medicaid-paid help at home for adults who need a nursing-home level of care, with personal attendant care, case management, and skilled nursing. Through Personal Options a member can hire their own attendant, and while a spouse or court-appointed legal guardian cannot be paid, other relatives are not barred. Slots are limited, so many applicants first wait on the Managed Enrollment List. Meanwhile a parent's Medicare paperwork piles up. That split is exactly where an advocate fits: you handle the caregiving, we handle the Medicare side. See how the waiver, the Medicare Savings Programs, and Medicare fit together on our West Virginia hub.
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Three doors, all worth knowing. For free, unbiased counseling on plans and enrollment, West Virginia's State Health Insurance Assistance Program, WV SHIP (run by the West Virginia Bureau of Senior Services), at 1-877-987-4463. For local services such as meals, rides, caregiver support, and in-home help, the Area Agency on Aging that serves Boone County, the WVSU-Metro Area Agency on Aging in Cross Lanes, at 304-720-6858 (or the Bureau of Senior Services toll-free at (877) 987-3646, or the national Eldercare Locator at 1-800-677-1116). And for one dedicated advocate who does the ongoing work with you, bills, denials, appointments, and benefits, Understood Care, covered by Medicare for most members and usually $0: call (646) 904-4027 or get started online.
Yes. Medicare has paid for professional healthcare navigation (Principal Illness Navigation and Community Health Integration services) since January 2024. Part B covers about 80% and a Medigap plan typically covers the rest, so most members in Boone County pay $0. We confirm your exact coverage before your first session, and there are no surprise bills.
Per CMS enrollment data for 2025, Boone County had 5,770 Medicare beneficiaries: 3,989 on Medicare Advantage plans (69.1%) and 1,781 on Original Medicare, with about 1,240 dual-eligible for both Medicare and Medicaid. Understood Care advocates work with both: Original Medicare members usually pay $0 through Part B plus a supplement, and we confirm Medicare Advantage coverage plan by plan before any work begins.
Per the US Census Bureau's American Community Survey, about 663 of Madison's 2,840 residents are 65 or older (23.3%), within a county of roughly 4,606 seniors (Boone County). Most become Medicare-eligible at 65, and every one of them has the same federal benefits an advocate helps put to work.
Per CMS Timely & Effective Care data (period ending 09/30/2025), the median ER visit at Boone Memorial Hospital runs about 105 minutes; West Virginia's statewide median is 141 minutes. An advocate cannot shorten an ER line, but avoiding the ER for non-emergencies is advocate work: same-week appointments, urgent-care routing, and follow-up coordination.
No. Understood Care is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Madison as anywhere else in West Virginia's 55 counties. Where the nearest specialist is a long drive away, an advocate you can reach without the trip is often the practical option; if leaving home is hard, that is exactly the situation the service is built for.
Advocates work virtually and are matched to you, not to a zip code. You get one dedicated advocate with their direct phone, email, and text (One Advocate, For Life), and they work with West Virginia's programs, WV SHIP counseling, the Medicare Savings Programs the Department of Human Services decides, the Aged and Disabled Waiver and other home care programs, and the local services that apply in Boone County.
West Virginia's main Medicaid path to care at home is the Aged and Disabled Waiver, run by the Bureau for Medical Services: it serves adults 18 and older who need a nursing-home level of care but choose to stay home, with personal attendant care, case management, skilled nursing, non-medical transportation, and a personal emergency response system. Through Personal Options, members can hire and direct their own attendants; spouses and court-appointed legal guardians cannot be paid caregivers, but other relatives are not barred. When no funded slot is open, applicants wait on the Managed Enrollment List. West Virginia has no PACE program yet. To apply for Medicaid, use WV PATH or call the Department of Human Services at 1-877-716-1212; for meals, rides, and caregiver support in Boone County, call the WVSU-Metro Area Agency on Aging in Cross Lanes at 304-720-6858. Families we serve in Charleston & the Kanawha Valley use these programs. Our advocacy is billed through Medicare, so for dual-eligible families the split works well: you run the caregiving, and your parent's advocate handles the Medicare side.
In West Virginia we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~15% of West Virginia MA members); Highmark Blue Cross Blue Shield Medicare Advantage plans (~15% of West Virginia MA members); Aetna Medicare Advantage plans (~8% of West Virginia MA members). Together that covers roughly 66.7% of West Virginia'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.
Charleston & the Kanawha Valley
Charleston · South Charleston · St. Albans · Dunbar · Nitro · Hurricane · Winfield · All of West Virginia
Local figures: US Census Bureau American Community Survey (2023, 5-year), CMS Medicare Monthly Enrollment (2025), and CMS Care Compare, retrieved 2026-10-09. Statewide program facts were last verified on 2026-10-09; sources are listed on the West Virginia hub, and the full county tables are on West Virginia Medicare by the numbers. Understood Care is an independent private advocacy service and is not affiliated with any government agency or any hospital named above.