Does Medicare cover a care navigator? What it costs, honestly

Yes. Since January 2024, Medicare covers care navigation for people with a serious illness, under a service called Principal Illness Navigation. It is a real benefit with real billing codes, not a courtesy program that gets cut when budgets get tight.

Here is the honest version of what it costs.

Most patients pay nothing

That is the practical answer for the majority of the people we enroll. It is not a marketing line, it is what the coverage rules produce for most Medicare members with a serious illness.

The part where cost sharing can apply

Principal Illness Navigation is a Part B service. Part B services carry standard cost sharing, which means a coinsurance amount can apply the same way it would for an office visit.

Two things matter:

• If you have full Medicaid or QMB, that cost sharing is waived. You pay nothing.
• If you have a supplement or secondary plan, it usually picks up the coinsurance.

We check your coverage before you start and tell you your exact cost. Nobody gets enrolled and surprised later.

How the billing actually works

Medicare pays for navigation by the time spent on your care in a calendar month. Not by the visit, and not by a flat monthly fee.

• The first hour of navigation work in a month is billed under code G0023.
• Each additional half hour is billed under G0024.
• There is a monthly ceiling, so the total is capped no matter how heavy the month gets.

Only certain work counts. Coordination calls, records review, insurance work, appointment and transport arrangement, family communication, and the practitioner-directed care planning all count. Time your navigator spends on other patients, or on general administrative work that is not about you, does not.

What you are not paying for separately

You are not paying extra for:

• The monthly check-in call.
• The written monthly summary to your family.
• Calls you make to your navigator between check-ins.
• Prior authorization and appeal work.
• Arranging medical transportation.

Those are all part of the service.

Medicare Advantage counts too

Original Medicare or a Medicare Advantage plan both work. Plan rules on cost sharing can differ, which is another reason we check before you start.

Can you stop?

Any time, for any reason. Tell your navigator and it stops. Billing stops with it, and nothing about your regular care changes.

Find out your number

Call 973-607-4911. We will check your coverage and tell you your exact cost before anything begins.

Where this comes from

• Medicare costs at a glance — deductible and 20% coinsurance basics.
• Medicare Savings Programs — help paying Part B cost sharing.
• CMS CY2024 Physician Fee Schedule final rule fact sheet — where the navigation codes are defined.

Related reading on this site

• What it costs, in full
• Who qualifies
• What is Principal Illness Navigation?