Principal illness navigation services
Medicare Part B (Medical Insurance) covers principal illness navigation services if you’re eligible
Description
Principal illness navigation is a type of care management that helps patients understand their medical condition or diagnosis and guides them through the health care system.
Coverage details
If you have more than one serious condition, you can get principal illness navigation services for each condition. For example, if you’re getting navigation services for substance use disorder and then you’re diagnosed with cancer, you can get navigation services for both conditions.
Who's eligible
If you have a serious condition that’s expected to last at least 3 months (like cancer, HIV, or substance use disorder) and puts you at a high risk for one or more of the following:
- Hospitalization
- Nursing home placement
- A sudden worsening of preexisting symptoms
- Physical or mental decline
- Death
Provider requirements
Your provider or their staff can give you the navigation services or refer you to other trained personnel (including patient navigators or peer support specialists) for the services.
Costs
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount .
How often
- You must have an initial visit with your doctor or other health care provider before you can start getting principal illness navigation services.
- After your initial visit, you can get navigation services monthly for as long as you need them through the rest of the year.
- After a year, you’ll need another initial visit if you continue to need these services.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service