Does Medicare Pay for a Patient Advocate?

Medicare does not pay for a patient advocate by that name. But it does pay doctors' offices and care teams to help you between visits. That can mean a care plan and a number to call day or night. It can also mean a check of your medicines and help finding care. You agree to it first, and you usually pay 20%. If you're juggling a few doctors, refills and bills, you may just want one person to help sort it out.

Medicare pays for care coordination if

• You have Part B, the part of Medicare that pays for doctor visits.
• Your doctor's office or care team offers the service and is enrolled in Medicare.
• You have the health problems the service is for, as the table below shows.
• You agree to it, and the office will ask for your OK first, sometimes in writing.

Not sure Medicare will pay? Ask anyway, because your doctor's office can tell you which of these it offers. Or a Pair Team advocate can check with you.

Care coordination services Medicare pays for (2026)

What will I pay?

You'll pay 20% of Medicare's approved amount for each service. That's after the $283 yearly deductible for doctor care in 2026. Most are billed once a month, so ask the office what the monthly amount is. Many people with both Medicare and Medicaid pay nothing for Advanced Primary Care Management, Medicare.gov says. The Qualified Medicare Beneficiary (QMB) program is one of the Medicare Savings Programs. If you have it, no one can bill you for the 20%. For more, see Medicare and Medicaid together.

Where can I get help without paying an advocate?

You can get help without paying an advocate from these programs when a problem isn't getting fixed.

• SHIP gives free, one-on-one counseling on Medicare, bills and complaints at 1-877-839-2675 or shiphelp.org. In California, call 1-800-434-0222, and in New York, call 1-800-701-0501.
• The Medicare Beneficiary Ombudsman can help if Medicare or your plan hasn't fixed a problem. Call 1-800-MEDICARE (1-800-633-4227) and ask them to send it to the Ombudsman.
• The Quality Improvement Organization (QIO) handles fast appeals and complaints about the quality of your care. In California and New York, it's Commence Health: 877-588-1123 in California, 866-815-5440 in New York.
• The Long-Term Care Ombudsman works on problems for people who live in a nursing home or assisted living. To find yours, call the Eldercare Locator at 1-800-677-1116.

If Medicare turned down a claim, see how to appeal a Medicare denial.

What about a private patient advocate?

You usually pay a private patient advocate yourself, often by the hour. That's what Greater National Advocates, a nonprofit directory, tells families. Medicare pays for navigation and care coordination only when it comes from a provider enrolled in Medicare. Before you hire anyone, ask, "Do you bill Medicare?" and "What will I owe each month?"

How to get started

1. Ask your primary care office, "Do you offer Chronic Care Management or Advanced Primary Care Management?"
2. Ask about navigation if you have a serious illness. Ask about a community health worker if food, housing or rides get in the way of care.
3. Ask what you'll owe each month, and whether your other coverage pays the 20%, so there are no surprises.
4. Go to the first visit. Navigation and community health worker help start with a visit with your provider. So does Advanced Primary Care Management, unless you've seen that office in the last 3 years.
5. Give your OK, then save the team's number where you can find it, so help is one call away.

For more on finding care, see how to find a doctor who takes Medicare.

What a Pair Team advocate does

People who call us rarely need just one thing. Often a refill ran out and the specialist visit is weeks away. This is what we do:

• Give you one care team to call, with nurse practitioners, nurses and care managers.
• Make appointments, follow up on referrals, and help with refills.
• Set up rides to appointments, and help with food, utility bills and housing.
• Help with Medicaid and Medicare Savings Program forms, and with medical bills you shouldn't have gotten.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Does a Medicare Advantage plan pay for care coordination?

Care coordination in a Medicare Advantage plan depends on the plan, so check with yours. Your costs for Advanced Primary Care Management may be different in a Medicare Advantage plan, Medicare.gov says. Call the number on your plan card.

Can my caregiver get help too?

Yes, Medicare pays a provider to train your family caregiver when it's part of your treatment plan. The training can happen without you in the room.

Who will I talk to?

Who you'll talk to depends on the service. It may be a nurse, a care manager, a patient navigator, a peer support specialist or a community health worker. They work under your doctor or nurse practitioner.

Why did I get a bill for care management?

If you have QMB, you shouldn't get a bill for care management at all. Otherwise, these services carry a 20% share, like most doctor care. If you didn't agree to the service, call the office and ask about it.

Is a SHIP counselor the same as a patient advocate?

No, a SHIP counselor answers Medicare questions, like billing problems or how Medicare works with other coverage. A care team works on your health care itself.

Can I stop?

Yes, you can stop Advanced Primary Care Management at any time by telling your provider, Medicare.gov says. For the other services, tell the office you want to stop.

Sources

• Chronic care management services, Medicare.gov
• Principal illness navigation services, Medicare.gov
• Community health integration services, Medicare.gov
• Advanced Primary Care Management services, Medicare.gov
• Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule, CMS
• Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule, CMS
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• Get help with your rights and protections, Medicare.gov
• Caregiver training services, Medicare.gov
• Qualified Medicare Beneficiary (QMB) Program, CMS
• Long-Term Care Ombudsman Program, Administration for Community Living
• Eldercare Locator, Administration for Community Living
• State Health Insurance Assistance Programs
• Independent Patient Advocates, Greater National Advocates