On Medicare?
Medicare recently opened the door to cover certain care coordination and navigation services. For tens of thousands of patients, it can be an absolute lifesaver, but there is red tape and fine print.
Whatever your situation, GNA is here to help you take the next step.
Independent. Nonprofit. Nationwide.
We take no money from hospitals, insurers, or listed advocates.
We answer only to patients and loved ones.
How an Advocate Can Help
When you are dealing with a complex health issue, a qualified advocate cuts through the chaos.
- Understand diagnoses and treatment options
- Prepare for medical appointments
- Coordinate communication betwee providers
- Identify helpful resources and support services
- Address barriers that affect access to care
- Understand what comes next
Finding the Right Path for You
Free, independent guidance to help you understand your options and choose the path that's right for you.
When you aren't sure where to begin, the GNA Advocacy Support Center's free guidance program helps you and your loved ones sort through the confusion and weigh your options.
Sometimes, advocacy paid for by Medicare can't meet a patient's needs. That's where private, cash pay Independent Patient Advocates shine. Free from government red tape, they can provide the comprehensive support that Medicare simply won't cover.
Whether the answer is a nonprofit resource, resolving the issue on your own, or connecting with a cash pay Independent Patient Advocate through our directory, we'll help you understand your options so you can make an informed decision about what comes next.
Why This Reality Check Matters
While Medicare-covered advocacy is an important resource, there are limitations. Some examples:
- If you need help right away, the intake process typically takes days.
- Medicare does not cover patient advocacy services in hospitals, acute care settings, or skilled nursing facilities. Some Medicare Advantage plans do not cover advocacy.
- For Medicare Advantage, the agency must be in-network with your plan, just like your doctors.
- Some agencies or Advantage plans may set limits on the number of hours of advocacy available per month.
- The patient must have a qualifying health condition.
- The patient desires an advocate in-person. While Medicare will cover in-person, most agencies do not offer this service.
America’s nonprofit gateway to Independent Patient Advocacy. We guide. You choose.
Support When Healthcare Gets Complicated
Advocates help patients and loved ones understand their situation, coordinate care, identify problems early, and prepare for difficult decisions.
Not Sure Where to Start?
GNA helps patients and loved ones understand their options. Whether the right fit is Medicare-supported help, private-pay advocacy, or another form of support, we offer free, independent guidance to help you find the right support.
How the Process Works
- Choose an advocate or agency
- Complete the insurance verification and intake steps (usually a call)
- Meet with the overseeing provider, develop your advocacy care plan
- Meet with your advocate
Frequently Asked Questions
Coverage rules, eligibility requirements, and available services can vary. The questions below address some of the most common topics related to Medicare-supported patient advocacy services.
Does Medicare really pay for patient advocacy services?
Yes. Since 2024, Medicare covers certain navigation and care coordination services — many of the same services that private-pay patient advocates have traditionally offered.The patient’s conditions and these services must meet Medicare’s eligibility and billing requirements.
What types of advocacy services can Medicare cover?
Some examples of services that Medicare might cover could include help preparing for appointments, coordinating communication between providers, understanding treatment plans, managing follow up care, and addressing barriers that affect access to care. Coverage applies only when services meet Medicare's specific rules.
Who qualifies for Medicare covered advocacy services?
Eligibility generally requires enrollment in Original Medicare (Part B) or a Medicare Advantage plan that offers these services. Patients must have a serious, ongoing, or complex medical condition. A medical provider also must evaluate the patient and provide a referral for these services.
Additionally, patients cannot be receiving services under Medicare Part A such as hospitalization, certain types of rehabilitation centers, or nursing homes. Patients may be receiving services under Medicaid and still be eligible in some circumstances. Your advocate will best be able to determine whether their services will be covered in your specific scenario.
Does Medicare Advantage cover these services?
Coverage under Medicare Advantage plans varies. Most plans include navigation or care coordination benefits. It is important to review your specific plan details. The plan must both cover advocacy AND the specific advocacy agency must be in network with your plan. You may need to call several to locate an agency who is in-network.
Will I have out of pocket costs?
You might. If you have Original Part B, cost sharing may apply, including coinsurance. If you have an Advantage plan, costs will be determined by your specific plan’s copay and cost-sharing policies. If you have secondary or supplemental coverage, such as Medicaid or Medigap, copay and coinsurance costs may be reduced or eliminated. Some agencies may waive any copayments; each agency handles their own billing, contracts and fee programs.
Are all Independent Patient Advocates covered by Medicare?
No. Only advocacy services delivered under approved Medicare billing models are covered. Many independent advocates operate outside of Medicare and provide services only through private pay arrangements.
What if I do not qualify for Medicare covered services?
Many advocates offer alternative payment options, including private pay, sliding scale arrangements, or limited pro bono support. Payment structures vary by advocate. Our Advocacy Support Center can help you find what resources are available to you.
How do I find advocates who participate in Medicare covered services?
Visit our Medicare Group page to explore participating advocates and agencies.
Why is the list of advocates available different if I choose Traditional Medicare or Medicare Advantage?
With Medicare Advantage, the agency providing the services must be in network with the particular advantage plan - just like your doctor or any other provider. With Traditional Medicare, any agency who accepts Medicare accepts all traditional Medicare AND Medigap plans.
NOTE: Just because an agency accepts some Medicare Advantage plans does not mean they accept your specific plan. The agency or advocate will determine your eligibility.