All Channels

Hi Marty! Your question is very interesting.

Medicare eligibility due to disability is usually connected to SSDI, not SSI. In most cases, once a person is approved for SSDI, there is a 24-month waiting period before Medicare coverage can begin.

Because every situation is different, the best next step would be for the patient to contact the Social Security Administration directly to confirm whether he may qualify for SSDI. My understanding is that the 40-quarter requirement is mainly related to retirement benefits, and SSA may apply different work-credit rules for disability benefits, especially for younger individuals who have not had enough time to build a long work history.

It may also be helpful for the patient to ask SSA to explain the possible benefits, limitations, and long-term impact before making a final decision. If disability benefits are approved at a young age, it may have future implications for earnings and benefits, so it is important that he receives guidance directly from SSA.

My suggestion is for the patient to call SSA, confirm his eligibility, ask about the pros and cons, and then decide whether moving forward with the SSDI application is the best option for his situation.

I truly hope this info helps you guide your patient toward the next steps that are best for her/his/their situation. Have a great day!

If someone is receiving SSI/SSDI under the age of 65 they will be eligible for medicare after 2 years. I would find out why the procedure is not covered and go from there.

I believe after 2 years they become eligible for Medicare. What’s their diagnosis and what is the procedure?

Thanks for sharing! And welcome to this space for fellow patient advocates!

This is an awesome background story behind your reason for advocacy

Here is an investigative article I recently wrote on WISeR: www.thinkglobalhealth.org/article/ai-driven-pilot-program-delays-access-to-care-for-americans

Good information to know. Thank you Dalia.

Good information. I have an investigative journalism piece on WISeR that will likely be published later this month and will share.

Kim this is a great idea. Although I am not a social worker, I would love to join!

Hi Kim, I would love to join. Please add me to the event list. I look forward to talking soon! — Lauren

This is such a thoughtful and meaningful topic, Kim. You really made me reflect!

I’m not a social work advocate, but I truly enjoy learning from different perspectives and experiences. I’ll work on my list over the next three weeks so I can be ready for your roundtable.

Looking forward to it!

I'd love to attend

looks good.

Great, clear approach Kim. Wishing you the best!

Thanks so much for being here Kim, and also for being a great volunteer to GNA's Advocacy Support Center team!

Thank you for sharing such a powerful and personal story. Your message is an important reminder that every patient deserves dignity, respect, and compassionate care, regardless of their size or health condition. I appreciate your willingness to speak up for those who often feel unseen or unheard. You are a force!!!

Dalia,
First, i'm so incredibly sorry for what your family went through. NO ONE should ever be treatd that way, for any reason whatsoever.

Second, YES! THANK YOU for saying what is so often unsaid — that weight is about so much more than willpower.

My youngest was a competitive bicyclist. She regularly went, literally 100 miles in a day on her bike. When we were seeing docs about her post-exertional malaise and her orthostatic intolerance, EVERYONE tried to blame her weight. When i explained how fit the girl was, then they would blame overtraining and yet also somehow come back to it being due to her weight. Drove me CRAZY and drove her away from medical care for a long time.

THANK YOu for saying what needs to be said.

Nice to meet you, Sasha!
I noticed that your work is bilingual and accessible, and your profile also mentions that you understand Spanish, so I wanted to say: Mucho gusto, compañera. Muchas bendiciones para ti y tu familia.

Sasha,

I'm so glad you're here and that you introduced yourself! I now realize I never introduced myself, so I'm going to do that now! Kim

Sasha,
THANK YOU for such a great introduction! We're so glad you're here. we hope you find helpful information and connection with us here.

I do not know any SLPs in that area, however, you can check the state licensing board to see if they have a directory. shp.ohio.gov/for-the-public

also, here are advocates within 75 miles of that location that may have some guidance for you:
gnanow.org/advocates?search_type=speciality_id&speciality_id=18&locations=Columbus%2C+OH+43085%2C+USA&distance=75

Here are adovcates who are m ost likely to have those connections:

Angie Galatas, SLP gnanow.org/advocates/medi.html
Shlomit Liberty, SLP gnanow.org/advocates/shlomit.html
Hannah Klassy, SLP of Dementia Dimensions gnanow.org/advocates/hannah-klassy.html

Casandera,
Thank you SOOO much for sharing this!

If you don't mind, I'd love to add a few thoughts…

1. If a newer advocate is looking to get out of their comfort zone, to learn types of things clients ask and to connect with other advocates, please contact me about volunteering with GNA's Advocacy Support Center («ASC»). We aren't a live hotline, but advocates are talking to real clients in need, helping to route them to the best resources.

2. If any advocate ever has a case they need help finding other advocates to consult, to contract under, or to make a warm handoff — again the ASC is here for you. POSTS LIKE THIS ARE IDEAL — and also, you're very welcome to ask our team to do a deep dive search of our directory and look for advocates who have the knowledge you're seeking.

Hav a GREAT day and thanks again for posting!

I'm considering using Carepatron. It is HIPAA-compliant and fairly inexpensive. They do offer a Business Associate Agreement (BAA), and I believe you will send an invite to the email address so the client can do the visit on their phone.

I have attended virtual appointments with my client in the past. How I do it is have the facility or doctor send me the link and attend with the client at her home.
Another client calls me and puts me on speaker when the doctor comes into the room to see her.

Kathaleen, GREAT question! I hope you get lots of response!

I haven't personally done it, but I have spoken with several patients that have had their advocate on the phone during an appointment — letting the provider know that of course upon the provider's arrival.

I'm super curious to see if others have insights as well!

Karen, this is GREAT! Would you consider also making it a blog post with us? in your «gna dashboard» is the blog creator. You can simply copy/paste it there, do any edits you need.

At the BOTTOM you are welcome to write a brief bio and to include information on your free resource site.

This is very helpful. Thank you for sharing!

AI won’t replace patient advocates. But advocates who use AI will replace those who don’t. You don't need to become a tech genius, you just need to know how to use these tools securely, ethically, and efficiently to protect your time and your practice.

My course, «AI? Piece of Cake,» is built specifically for our profession with zero fluff and straight-to-the-point workflows. Bonus: it earns you 2.0 JEDI CE credits. You'll also qualify for Sonoran Wayfinders' digital badge, Responsible AI Advocate.

Renae, thanks so much for sharing this informative pst. I hope others will ask questions or share what's working for them!

I would really like to connect with others about this because I have been working on this issue for over a year.

When Medicare began covering Principal Illness Navigation (PIN) services in 2024, I was very hopeful that this would finally give more patients access to professional navigation services. Unfortunately, as an independent navigator, I have found actually getting these services reimbursed to be extremely difficult.

In the process I have been working through, the treating practitioner who establishes the care plan—such as the oncologist or radiation oncologist—must be involved, and the navigator's services are connected to that practitioner's billing. I have also encountered requirements involving reassignment of benefits and documentation identifying the PIN services/navigation being provided. In my situation, we have been working with the G0023/G0024 PIN service codes.

This is where I keep hitting a wall.

Many physicians and practices understandably do not want to enter into a reassignment/billing arrangement with an independent navigator because of the administrative responsibility, compliance concerns and potential risk to their practice.

I have had several conversations and meetings regarding Medicare enrollment and billing trying to determine whether there is a compliant way for an independent PIN to provide these services without creating such a burden for the treating physician. So far, I have not found a workable solution.

What frustrates me most is the impact on patients. I see people who genuinely need navigation services but cannot afford private-pay advocacy. Medicare created PIN services specifically to address many of these needs, yet accessing the benefit through an independent navigator seems incredibly difficult.

Has anyone here successfully created a model where an independent navigator provides PIN services that are billed to Medicare?

I would especially love to hear:

• How are you structured with the physician/practice?
• Who bills Medicare?
• Did you need a reassignment of benefits?
• How did you handle the initiating visit and care plan requirements?
• How are you compensated by the billing practice?
• Have you found a compliant model that doesn't place an unreasonable administrative burden on the physician?

If anyone has successfully navigated this, I would really appreciate connecting and comparing notes. After more than a year of working on it, I would love to find a practical solution—especially because there are so many patients who need these services and simply cannot afford to pay for them out of pocket. Feel free to contact me via email at Aimee@CCC.Care or leave me a message here. Thanks

Hi Natasha,
The only Independent Advocate that I know that is billing Medicare is Terry McLellan — Sunnavhca. She is located in TX. I'm sure she will be happy to have a conversation with you. Here's her email: terry@sunnavhca.com
Let her know I referred you.
Tammy