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

Yes, all 254 counties. The service is fully virtual, delivered by phone, video, and secure messaging, so it works the same in Houston, San Antonio, Dallas, Austin, Fort Worth, El Paso, the Rio Grande Valley, West Texas, and every rural county in between. 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 Texas's programs like HICAP, the Medicare Savings Programs, and STAR+PLUS, and gives you their direct phone, email, and text, so you never start over with a stranger in a call queue.

Not the way a few states allow. Texas follows the federal rule: you get one guaranteed six-month Medigap Open Enrollment Period that starts when you are 65 and enrolled in Part B, and there is no year-round switching or annual window. Miss it and insurers can medically underwrite. Texas does add protections above the federal floor: under-65 beneficiaries on Medicare for a disability get a guaranteed-issue right to at least Plan A, and a 2025 law (HB 2516) opened a window for people with ESRD or ALS. Because the timing matters so much here, this is exactly where an advocate helps.

CDS is Texas Medicaid's self-direction option, offered through STAR+PLUS, and it lets a member hire and direct their own attendant, including paying a qualifying family member. Many families we serve use it. 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 CDS caregiving, and your parent's advocate handles the Medicare paperwork.

HICAP is Texas's free Medicare counseling program (1-800-252-9240), delivered through the state's 28 Area Agencies on Aging, 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 members to HICAP counselors for enrollment-season plan comparisons.

In Texas we are in-network for Original Medicare (traditional fee-for-service Medicare); UnitedHealthcare Medicare Advantage plans (~50% of Texas MA members); Humana Medicare Advantage plans (~27% of Texas MA members); Blue Cross Blue Shield Medicare Advantage Medicare Advantage plans (~4% of Texas MA members); Texas Blue Cross Blue Shield Medicare Advantage plans (~4% of Texas MA members); Wellcare Medicare Advantage plans (~4% of Texas MA members); WellMed Medicare Advantage plans. Together that covers roughly 94.1% of Texas'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.