What Are Healthcare Advocates?

Introduction

In short: If you are managing appointments, test results, new diagnoses, and insurance questions, the healthcare system can feel overwhelming.

If you are managing appointments, test results, new diagnoses, and insurance questions, the healthcare system can feel overwhelming. A healthcare advocate is a person who helps you navigate all of this with clarity and confidence. Advocates work alongside you and your family to explain choices, prepare for visits, coordinate next steps, and make sure your concerns are heard.

This guide explains what healthcare advocates are, how they help, when to consider one, and how to choose and work with an advocate while protecting your privacy and rights.

Who healthcare advocates are

In short: Who healthcare advocates are: Healthcare advocates include several helpful roles that often overlap

Healthcare advocates include several helpful roles that often overlap

Patient navigators guide people through screening, diagnosis, treatment, and follow up, especially when barriers make care hard to access.
Nurse navigators are registered nurses who provide clinical education, triage concerns, and coordinate care plans.
Community health workers are trusted community members who connect people to medical and social supports, address transportation and housing needs, and help with follow up on care plans.
Patient representatives or patient experience teams at hospitals and clinics help with questions, concerns, and problem solving inside that organization.
Long term care ombudsmen advocate for residents in nursing homes and assisted living, help resolve complaints, and protect residents’ rights.

What healthcare advocates do

In short: What healthcare advocates do: Advocates focus on practical help that reduces stress and improves safety

Advocates focus on practical help that reduces stress and improves safety

Prepare you for appointments by organizing questions and key information you want to cover
Help you understand test results, diagnoses, and care options so you can make informed choices
Coordinate communication among primary care, specialists, therapists, and your support network
Arrange transportation, gather records, and track referrals and follow up tasks
Help with insurance questions, prior authorization, and financial assistance programs
Connect you with community resources for food, housing, mobility, and social support
Support shared decision making so your values guide the plan of care

What Are Healthcare Advocates? — Healthcare advocates guide you through options, visits, insurance, bills, and local resources, with clear support, privacy protections, and Medicare know-how

Why advocates matter

In short: Research and national programs show that navigation and patient engagement can improve access to timely care, reduce barriers, and support better outcomes.

Research and national programs show that navigation and patient engagement can improve access to timely care, reduce barriers, and support better outcomes. Programs that pair navigation with community support help people follow through on screening and treatment and can reduce gaps in care for underserved communities. Hospitals and clinics also invest in patient experience teams and representatives because partnering with patients and families improves safety and quality.

How advocates fit into Medicare support

In short: Beginning in 2024, Medicare added new services that recognize and support care navigation and help with health related social needs.

Beginning in 2024, Medicare added new services that recognize and support care navigation and help with health related social needs. These services can help people with serious or complex conditions stay on track with care plans and address obstacles such as transportation or medication access. To learn if these services fit your needs and how to get started, contact Understood Care at (646) 904-4027 or sign up at https://app.understoodcare.com/

When to consider a healthcare advocate

In short: When to consider a healthcare advocate: You may benefit from an advocate if you

You may benefit from an advocate if you

Have a new diagnosis, a hospital discharge, or a complex treatment plan
See multiple clinicians and want help keeping everyone aligned
Feel unsure about next steps or want a second opinion
Need help with insurance denials, billing questions, or financial aid applications
Face barriers like transportation, language, housing, or caregiving strain
Live in a nursing home or assisted living and want help with concerns or complaints

How to choose an advocate

Understood Care will pair you with an advocate who is a strong match for your individual needs.

Experience with your health needs or care setting
Clear explanation of services, availability, and how they coordinate with your clinicians
Respect for your preferences, culture, and communication style
Strong privacy practices, including clear steps for consent and information sharing
Positive references or a connection to a trusted health system, community program, or long term care ombudsman office

If you are receiving care at a hospital or clinic, you can reach out to us at (646) 904-4027 or sign up to meet with an advocate at https://app.understoodcare.com/. If you or a loved one needs long term care, contact us and we will help you explore options and get the care you need.

In short: Privacy, consent, and your rights: You stay in charge of your health information.

You stay in charge of your health information. Understood Care assigns an advocate based on your individual unique needs. You can name your Understood Care advocate to speak with your clinicians and health plan. For medical visits and records, federal privacy rules allow you to give written permission so your information can be shared with your advocate. If you want help with Medicare claims or appeals, an Understood Care advocate can be formally appointed to act on your behalf, and we handle the paperwork and communication for you.

Key steps

Tell your clinicians in writing who may be present during visits and who can receive updates
Complete any authorization forms the clinic or hospital requires
Keep copies of signed forms for your records
For Medicare claims or appeals, complete the Appointment of Representative form if you want someone to act on your behalf

Your designated Understood Care advocate can help with all of this.

How to work well with an advocate

In short: How to work well with an advocate: Bring a short list of your top questions to each visitShare a current medication list and any allergiesAsk your.

Bring a short list of your top questions to each visit
Share a current medication list and any allergies
Ask your advocate to summarize next steps after each appointment
Decide together how and when you want updates, such as by phone or video call
Review what information you want shared and what should stay private

Free tools can help you prepare questions for your visits and make the most of your time with your clinician.
Here is a concrete example you can use https://www.ahrq.gov/sites/default/files/wysiwyg/patients-consumers/patient-involvement/ask-your-doctor/tips-and-tools/questionscard.pdf

Your Understood Care advocate can help you use these tools and tailor the questions to your needs.‍

FAQ

In short: FAQ: What is a healthcare advocate and why might I need one?

What is a healthcare advocate and why might I need one?
A healthcare advocate is a trusted guide who helps you navigate appointments, test results, diagnoses, insurance questions, and next steps. They work alongside you and your family to explain choices, prepare for visits, coordinate follow up, and make sure your concerns are heard so you feel more confident and less overwhelmed.
Who can serve as a healthcare advocate?
Healthcare advocates can include patient navigators, nurse navigators, community health workers, patient representatives at hospitals or clinics, and long term care ombudsmen. Their titles vary, but they all focus on helping you move through the healthcare system, understand your options, and resolve problems.
What do patient navigators and nurse navigators do?
Patient navigators guide people through screening, diagnosis, treatment, and follow up, especially when barriers like transportation or language make care hard to access. Nurse navigators are registered nurses who provide clinical education, triage symptoms, and coordinate care plans so you know who to see and when.
What is the role of community health workers and patient representatives?
Community health workers are trusted community members who connect people to medical care and social supports such as food, housing, and transportation. Patient representatives or patient experience staff in hospitals and clinics help answer questions, address concerns, and problem solve issues inside that organization.
What do long term care ombudsmen do?
Long term care ombudsmen advocate for residents of nursing homes and assisted living communities. They listen to concerns, help resolve complaints, and work to protect residents’ rights and quality of life.
What kinds of practical help can a healthcare advocate provide?
Advocates help you prepare for appointments by organizing questions and key information, explain test results and diagnoses in plain language, coordinate communication among your clinicians, arrange transportation, gather records, track referrals, and assist with insurance questions and financial assistance. They also connect you with community resources for food, housing, mobility, and social support.
Why do healthcare advocates matter for safety and outcomes?
Research and national programs show that navigation and patient engagement improve access to timely care, reduce barriers, and support better outcomes. When someone helps you follow through on screening, treatment, and follow up, you are less likely to miss important steps. Hospitals and clinics invest in patient experience teams because partnering with patients and families improves safety and quality.
How do healthcare advocates fit into Medicare support?
Beginning in 2024, Medicare added services that recognize and support care navigation and help with health related social needs. These services can assist people with serious or complex conditions by staying on track with care plans and addressing obstacles such as transportation, medication access, or home safety. Understood Care can help you understand whether these services apply to your situation and how to get started.
When should I consider working with a healthcare advocate?
You may benefit from an advocate if you have a new diagnosis, a recent hospital stay, or a complex treatment plan, if you see multiple clinicians and want help keeping everyone aligned, if you feel unsure about next steps or want a second opinion, if you have insurance or billing problems, or if you face barriers like transportation, language, housing, caregiving strain, or concerns in a nursing home or assisted living setting.
How do I choose an advocate who is a good fit?
Look for someone with experience in your health conditions or care setting, who clearly explains their services and availability, respects your preferences and culture, and has strong privacy practices. A connection to a trusted health system, community program, or long term care ombudsman office is also helpful. Understood Care pairs you with an advocate matched to your specific needs and can be reached by phone or through the online sign up.
How do privacy, consent, and my rights work with an advocate?
You stay in charge of your health information. You can name your Understood Care advocate as someone providers may talk to, and federal privacy rules allow you to give written permission so your clinicians can share information with that person. For Medicare claims or appeals, you can formally appoint an advocate as your representative. Your advocate can help complete these forms and keep copies for your records.
What steps should I take to allow an advocate to communicate with my care team?
Tell your clinicians in writing who may be present during visits and who can receive updates. Complete any authorization forms the clinic or hospital requires and keep copies. For Medicare matters, use the Appointment of Representative form if you want someone to act on your behalf. Your designated Understood Care advocate can walk you through each step.
How can I work effectively with a healthcare advocate?
Bring a short list of your top questions to each visit, share an up to date medication list and any allergies, and ask your advocate to summarize next steps after every appointment. Decide together how and when you want updates, such as by phone or video, and review what information you want shared and what should stay private. Free question cards and tools can help you prepare, and your advocate can tailor them to your needs.
How can Understood Care support me as my advocate?
Understood Care is a virtual service that connects you with a dedicated advocate who helps with calls, emails, appointments, and follow up. They coordinate with your clinicians, help organize paperwork, prepare you for visits, assist with Medicare questions and appeals, and connect you with community resources, all while respecting your privacy and preferences. You can start online or by calling to meet an advocate who will walk alongside you through your care.

References

In short: References: External Sources

External Sources

Centers for Disease Control and Prevention. Patient navigation overview.
https://www.cdc.gov/cancer/php/interventions/patient-navigation.html
National Cancer Institute. Definition of patient navigator.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/patient-navigator
Agency for Healthcare Research and Quality. Guide to patient and family engagement in hospital quality and safety.https://www.ahrq.gov/patient-safety/patients-families/engagingfamilies/index.html
Agency for Healthcare Research and Quality. Patient involvement resources and Question Builder.https://www.ahrq.gov/patients-consumers/patient-involvement/index.html
https://www.ahrq.gov/questions/question-builder/index.html
Centers for Disease Control and Prevention. Community health worker resources and role.https://www.cdc.gov/chronic-disease/php/community-health-worker-resources/index.htmlNational Institutes of Health Clinical Center. Patient representative role.https://www.cc.nih.gov/patient-services/representative
Cleveland Clinic. Office of Patient Experience programs and about the office.https://my.clevelandclinic.org/departments/patient-experience/depts/office-patient-experience/programs
https://my.clevelandclinic.org/departments/patient-experience/depts/office-patient-experience/aboutCleveland Clinic. What is an ombudsman.
https://my.clevelandclinic.org/health/articles/ombudsman
Administration for Community Living. Long term care ombudsman program.
https://acl.gov/programs/Protecting-Rights-and-Preventing-Abuse/Long-term-Care-Ombudsman-Program
U.S. Government Accountability Office. Long term care ombudsman program report.
https://www.gao.gov/products/gao-24-107209
Centers for Medicare and Medicaid Services. CY 2024 Medicare Physician Fee Schedule final rule fact sheet.
https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-ruleU.S. Department of Health and Human Services. Individuals’ right under HIPAA to access their health information.https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.htmlU.S. Department of Health and Human Services. HIPAA guidance on personal representatives.https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/personal-representatives/index.htmlCenters for Medicare and Medicaid Services. Appointment of Representative form CMS 1696.https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1696.pdf Centers for Medicare & Medicaid Services
Peer reviewed evidence on navigation and community health workershttps://pmc.ncbi.nlm.nih.gov/articles/PMC6299797/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5586005/
Historical context of patient navigationhttps://archive.cdc.gov/www_cdc_gov/dhdsp/chw_elearning/s1_p9.htmlNational Cancer Institute. Research advocacy at NCI and the Patient Advocate Steering Committee.
https://www.cancer.gov/about-nci/organization/oar/research-advocacy
https://www.cancer.gov/about-nci/organization/ccct/steering-committees/patient-advocate

This information is educational and does not replace medical advice. Always consult your clinician for care that fits your needs.

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.

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: April 3, 2026. 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: What Are Healthcare Advocates? — reviewed by the Understood Care Editorial Team.