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

Yes, all 72 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Metro Milwaukee and the Madison area as it does up the Fox Valley and Lake Winnebago, in Green Bay and along the lakeshore, out to Wausau and central and northern Wisconsin, and over to La Crosse and Eau Claire in the west. 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 Wisconsin's programs and rules: the state's own Medigap design (a Basic plan you customize with riders, not the federal letter plans A through N), the Medigap Helpline (free, commission-free Medicare counseling from the Wisconsin Board on Aging and Long Term Care), SeniorCare (Wisconsin's $30-a-year prescription drug program), the Medicare Savings Programs Wisconsin Medicaid runs, and the IRIS self-directed path where a family member can be hired to provide care, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Wisconsin is one of only three states, with Massachusetts and Minnesota, that does not use the federal Medigap letter plans (A through N). Instead, every Wisconsin policy starts from one standardized Basic plan, which already covers the Part B 20% coinsurance, 40 home health visits a year, the first three pints of blood, hospice and skilled-nursing coinsurance, and 365 additional lifetime hospital days. You then add optional riders one at a time, the Part A deductible, Part B excess charges, additional home health care (which lifts those 40 visits to 365 a year), and foreign travel emergency, plus lower-premium cost-sharing versions, all regulated by the Wisconsin Office of the Commissioner of Insurance under Wis. Admin. Code Ins 3.39. Because everyone starts from the same Basic plan, you can compare carriers on price. One timing trap: Wisconsin has no birthday rule and no annual guaranteed-issue window, so outside your six-month open enrollment at 65 an insurer can medically underwrite a switch. Knowing which riders fit your health and budget, and when you can move without underwriting, is exactly where an advocate helps. Wisconsin also requires insurers to sell the Basic plan to people under 65 who have Medicare because of a disability during their own six-month window, with a second open enrollment at 65.

Those run through Wisconsin Medicaid rather than Medicare. Wisconsin's self-directed option is IRIS (Include, Respect, I Self-Direct): the participant has budget and employer authority and hires and manages their own workers, and in Wisconsin a family member such as an adult child can be hired and paid to provide that care. Family Care and Family Care Partnership are the managed alternatives, and for adults 55+ in Kenosha, Milwaukee, Racine, and Waukesha counties, Community Care runs Wisconsin's 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 the Wisconsin Medicaid paperwork through your ADRC, and your parent's advocate handles the Medicare paperwork.

The Medigap Helpline (Wisconsin's State Health Insurance Assistance Program, reachable at 1-800-242-1060) is run through the Wisconsin Board on Aging and Long Term Care with trained, commission-free SHIP counselors, and it is excellent for one-off questions; your county's Aging and Disability Resource Center has Elder Benefit Specialists for the same. 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 the Medigap Helpline for enrollment-season plan comparisons.

In Wisconsin we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~45% of Wisconsin MA members); Humana Medicare Advantage plans (~12% of Wisconsin MA members); Aetna Medicare Advantage plans (~6% of Wisconsin MA members). Together that covers roughly 78.9% of Wisconsin'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.