Does Medicare cover a patient advocate?
Yes. Medicare covers patient advocacy through its care management programs. These pay a care team to help patients handle the practical obstacles and the coordination that get in the way of their care.
Medicare's care management programs
Medicare's care management programs covers help with the practical barriers that affect someone's health but are not medical treatment. It is the part of the benefit that recognizes a missed appointment is often a transportation problem, and an unfilled prescription is often a money problem.
- Transportation and getting to appointments
- Food, housing conditions, and utilities that affect health
- Difficulty navigating care, coverage, and paperwork
- Connecting to community programs and applying for them
Medicare's care management programs
Medicare's care management programs covers help for people with a serious, high-risk illness such as cancer, heart failure, advanced kidney disease, or dementia. It pays for a navigator to help the patient and family through treatment and everything around it.
- Coordinating care across specialists, hospitals, and primary care
- Explaining what was said and what happens next
- Tracking treatment logistics, authorizations, and follow-up
- Supporting the family alongside the patient
What you may pay
Careway bills Medicare directly. Standard Part B cost-sharing applies the same way it does to other covered services, which means a deductible and coinsurance may apply. If you have a supplemental insurance policy (Medigap) or Medicaid, your standard coinsurance may be fully covered. If you have both Medicare and Medicaid, you pay $0 out of pocket, because people with both programs cannot be billed for Medicare cost-sharing.
What it would cost without coverage
Independent patient advocates who are not billing Medicare are typically paid privately at hourly rates, which puts ongoing help out of reach for most families. That is what changed when these services became Medicare-covered.
Who qualifies
You need Medicare, and you need to live in a state Careway serves: California, Florida, Michigan, Ohio, or Wisconsin. No referral is required. Checking takes a couple of minutes, and we tell you plainly if the answer is no.
Questions about cost and coverage
For eligible Medicare patients, Medicare does. Careway bills Medicare directly for Medicare's care management programs, which cover this work. Advocates who do not bill Medicare are usually paid out of pocket.
Standard Part B cost-sharing applies, the same as for other covered services. If you have a supplemental insurance policy (Medigap) or Medicaid, your standard coinsurance may be fully covered, and people with both Medicare and Medicaid pay $0.
Careway works with Original Medicare and with select Medicare Advantage plans. The eligibility check tells you where your specific coverage stands. Careway does not sell or recommend any plan.
No. You can start on your own, and your advocate works alongside your existing doctors rather than replacing any of them.
No. Careway is a private healthcare provider, not a government agency, and is not affiliated with or endorsed by Medicare. Careway bills Medicare for covered services the same way a doctor's office does.
Talk to someone who can take this on
Checking whether you qualify takes a couple of minutes. If we are not the right fit, we will tell you plainly.
Covered by Medicare. If you have a supplemental policy (Medigap) or Medicaid, your standard coinsurance may be fully covered.