Principal illness navigation services

Medicare Part B (Medical Insurance)  covers principal illness navigation services 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

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. 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.

Your costs in Original Medicare

After you meet the Part B deductible , you pay 20% of the Medicare-approved amount .

What it is

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.

Things to know

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.

Is my test, item, or service covered?