Understood Care is a virtual patient-advocacy service for Medicare members.
Unlike case management or brokers, our advocates cover claims, appeals,
and care. Compared to helplines, it is one-to-one.
Expert help, tailored for your care journey is a Medicare topic. Expert help, tailored for your care journey refers to practical
guidance here. Expert help, tailored for your care journey — more below. Unlike generic summaries, we
cover Expert help, tailored for your care journey. Compared to other services, our advocates help
one-to-one with Expert help, tailored for your care journey.
Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care.
Short answer: Expert help, tailored for your care journey is a Medicare and patient-advocacy topic that refers to practical guidance for Medicare beneficiaries and their families. Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care. Understood Care advocates handle expert help, tailored for directly for members — unlike generic web summaries, this guidance is drawn from our case work with real Medicare beneficiaries across 50 states.
Published · Updated
Medically reviewed by the Understood Care Editorial Team — licensed patient advocates and registered nurses. Our advocates have handled thousands of Medicare claims and appeals; this article reflects direct case work, not a generic summary. How we research and review.
Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care.
What “expert help” means for you
In short: When your health gets complicated, having a dedicated guide can make the difference between feeling lost and feeling in control.
When your health gets complicated, having a dedicated guide can make the difference between feeling lost and feeling in control. Patient advocates help you understand your diagnosis and treatment plan, coordinate appointments, organize medications, and connect you with community resources. Research shows that patient navigation and coordinated care improve access to treatment, reduce delays, and support better outcomes, especially for people with chronic or serious conditions and for caregivers supporting a loved one [see References].
New Medicare-covered services that enable advocacy
As of January 1, 2024, Medicare created and pays for two care management services that formalize and fund this kind of hands-on help:
Principal Illness Navigation (PIN). Ongoing navigation for people living with a serious, high-risk condition that is expected to last at least three months. PIN focuses on education, barrier-reduction, and helping you follow a disease-specific care plan.
Community Health Integration (CHI). Personalized help addressing unmet social needs that get in the way of medical care, such as transportation, food access, housing stability, or health literacy. The goal is to remove practical barriers so your treatment plan can succeed.
Medicare’s own pages and rule summaries confirm that PIN and CHI became payable beginning in 2024, are delivered under the supervision of your clinician, and require an initiating visit with the practitioner who will bill for services. That initiating visit is a standard evaluation and management visit or similar covered service. It can be furnished by phone or video when Medicare telehealth rules allow, but it is not the same as an email or text message.
How our process works, step by step
In short: How our process works, step by step: This section draws directly from the video script so you know exactly what to expect.
This section draws directly from the video script so you know exactly what to expect.
1) Start the conversation
You can begin in two ways:
Fill out a simple form to request a visit and scheduling support. Visit the Understood Care home page and select Get Started to access the intake form.
Ask a general question by phone. If you are unsure whether you need an advocate, you can call to ask questions. If the intake team cannot answer, they will connect you with someone who can. We can answer questions and help you be your own advocate. We do not give medical diagnosis or prescribe care over the phone, but we can explain options and next steps.
2) Meet briefly with a provider
If you feel you need a dedicated advocate, your journey begins with a 20 to 30 minute visit with one of our providers. During this visit, the clinician reviews your health history as it relates to the support you are seeking and confirms whether PIN or CHI is appropriate. This visit serves as the initiating visit required by Medicare for PIN or CHI services.
Per Medicare guidance, the initial visit must be a real clinical encounter.
It must occur by phone or video for the first visit. Medicare does not consider email or text alone to be an initiating clinical visit.
3) Get matched with your dedicated patient advocate
After your provider visit, you are assigned a dedicated patient advocate. That person remains your point of contact for as long as you are an Understood Care patient. Your advocate coordinates closely with our clinical team so that your questions, goals, and day-to-day needs are understood and addressed.
4) Stay connected virtually
Both the visit with the provider and the first visit with your advocate are conducted by phone or video. Ongoing support also happens virtually so that you can access help from home, even if travel is difficult.
Expert help, tailored for your care journey — Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care
What a patient advocate actually does
In short: What a patient advocate actually does: Your advocate is your guide and problem-solver.
Your advocate is your guide and problem-solver. Typical ways we help:
Care coordination: scheduling and tracking appointments, sharing information between your doctors, and preparing you for visits so your questions get answered.
Treatment plan support: explaining diagnoses and instructions in plain language, helping you follow the care plan your clinician has set.
Medication organization: clarifying refills and timing, and identifying common barriers that cause missed doses.
Community connections: arranging transportation, home safety equipment, meal support, and other services that keep you well at home.
Caregiver support: helping family members understand the plan, organize tasks, and find respite resources.
Insurance navigation: answering Medicare questions, helping with claims or denials, and reducing paperwork stress.
These activities align with how Medicare defines the elements of PIN and CHI and are supported by strong evidence from peer-reviewed studies and national agencies.
Is this covered by Medicare?
In short: Is this covered by Medicare?: Yes, for most people with Medicare Part B.
Yes, for most people with Medicare Part B. Medicare pays for PIN and CHI when eligibility criteria are met and the required initiating visit has taken place.
You may have a copay. Standard Part B cost sharing can apply. Your advocate can help you understand potential costs before you begin.
Only one clinician bills per month per service. Medicare rules prevent duplicate billing for the same service in the same month, which keeps your care coordinated.
Why Medicare requires an initiating visit
In short: Why Medicare requires an initiating visit: The initiating visit verifies that:
The initiating visit verifies that:
You have a qualifying serious condition for PIN or an unmet social need interfering with care for CHI.
A responsible practitioner is supervising the service and has set or confirmed your plan of care.
Consent is obtained and documented. For PIN and CHI, Medicare allows consent to be written or verbal as long as it is recorded in your medical record.
Because it is a clinical service, the initiating visit must be a billable encounter with your practitioner and cannot be performed solely through email or text messages. Under current Medicare telehealth flexibilities, many initiating visits may occur by phone or video when applicable.
Expert help, tailored for your care journey — Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care
What you will notice day to day
In short: What you will notice day to day: Shorter to-do lists. We take on coordination so you can spend your time on healing, not phone trees.Fewer delays..
Shorter to-do lists. We take on coordination so you can spend your time on healing, not phone trees. Fewer delays. Navigation reduces common barriers that stall care, like missing records, transportation gaps, or confusion about instructions. More confidence and clarity. Advocates prepare you for visits, help you ask the right questions, and translate medical language into plain words. Support for your caregiver. Family and friends get tools and guidance so you do not have to carry everything alone.
How to get started today
In short: How to get started today: Meet your advocate team: Explore our advocates and the clinicians who supervise care.
Use the intake form: Share a few details and choose a time for your first provider visit.
Prefer a phone call? You can call and ask questions. If our intake team cannot answer, they will route you to someone who can.
Safety, privacy, and respect
In short: Safety, privacy, and respect: Understood Care follows HIPAA safeguards to protect your information.
Understood Care follows HIPAA safeguards to protect your information. Your advocate and clinicians coordinate with your permission, and your plan of care is documented so everyone on your team is working from the same page. Medicare rules also require annual consent for PIN and CHI to ensure you remain comfortable with services.
Tips to get the most from your advocate
In short: Tips to get the most from your advocate: Bring your priorities.
Bring your priorities. Write down your top two or three goals for the next month.
Prepare for visits. Keep a short list of questions and any new symptoms or barriers.
Create a shared calendar. Ask your advocate to help set reminders for appointments and refills.
Loop in your caregiver. Invite the person who helps you at home to join phone or video visits.
Speak up. If something is not working, say so. Your plan should be updated to fit your life.
Expert help, tailored for your care journey — Discover how Medicare-covered Principal Illness Navigation and Community Health Integration deliver patient advocacy, care coordination, and caregiver support at Understood Care
Frequently asked questions
In short: Frequently asked questions — overview for readers of Expert help, tailored for your care journey.
What is Principal Illness Navigation?
Principal Illness Navigation is a Medicare-covered care management service for people with a serious, high-risk condition expected to last at least three months. It includes education, barrier-reduction, and help following your disease-specific plan under your clinician’s supervision.
What is Community Health Integration?
Community Health Integration is help from trained staff to address unmet social needs that are blocking your medical care, such as transportation, food access, safe housing, or understanding medical instructions. The goal is to remove those barriers so your treatment plan can proceed.
Do I need an in-person visit to begin?
Usually no. The first step is a clinical initiating visit with the practitioner who will supervise PIN or CHI. Under current Medicare rules, many initiating visits can be performed by phone or video when eligible. Email or text alone does not qualify as an initiating clinical visit.
Can my caregiver talk with my advocate?
Yes, with your permission. Your advocate can include your caregiver in calls or video visits, share tools for organizing tasks, and connect them with education and support.
Will I pay anything out of pocket?
Medicare Part B typically covers these services. Standard cost sharing may apply, depending on your plan. We will review any expected costs with you before services begin.
How long does support last?
Your advocate stays with you as long as you remain an Understood Care patient and the service remains medically necessary under Medicare rules.
Is this different from case management at my health plan?
Yes. While both aim to coordinate care, PIN and CHI are clinical services delivered under your practitioner’s supervision, with specific elements and documentation requirements defined by Medicare.
References
In short: References: Centers for Medicare & Medicaid Services.
Centers for Medicare & Medicaid Services. Health-Related Social Needs FAQ. Answers questions about Principal Illness Navigation, Community Health Integration, caregiver training, and SDOH risk assessment, including initiating visit requirements, consent, supervision, and billing. https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
Agency for Healthcare Research and Quality. Care Coordination in Primary Care. Defines care coordination and goals for safer, more effective, patient-centered care. https://www.ahrq.gov/ncepcr/care/coordination.html
Springer Current Oncology Reports. Patient Navigation in Cancer Treatment: A Systematic Review. Synthesis of evidence that navigation improves access and treatment outcomes, particularly in underserved populations. https://link.springer.com/article/10.1007/s11912-024-01514-9
This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.
Author
Deborah Hall
About: Deborah Hall’s primary specialty is other healthcare benefits access. She helps people apply for coverage, clears questions, and connects them to programs fast.
Nutrition and food security
Housing
Community and Peer Support
Health literacy
Provider Access
Home safety access
Transportation
Medication access
DME access
Other healthcare benefits access
Other healthcare navigation
How we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat — state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
AI-assisted disclosure: This article is AI-assisted drafting, human reviewed — every published sentence was reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: Expert help, tailored for your care journey — reviewed by the Understood Care Editorial Team.
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