Key Takeaways:

• Patient advocacy services became eligible for Medicare reimbursement in 2024

• Baba's advocacy services are covered by traditional Medicare and many Medicare Advantage plans nationwide

• Most members pay little to nothing out of pocket for advocacy support

• A brief physician consultation determines your eligibility before you begin

If you've ever felt confused about what your Medicare plan covers, you're in good company.

Research shows that nearly two-thirds of Medicare beneficiaries find their coverage difficult to understand and navigate. And when you're dealing with health challenges, the last thing you need is the added stress of deciphering insurance policies and healthcare bureaucracy.

The good news? Significant changes in 2024 have made professional healthcare advocacy accessible to millions of older adults who need it most.

The Shift That Changed Everything

For years, patient advocacy remained an out-of-pocket service—helpful for those who could afford it, but out of reach for most Americans dealing with serious health conditions. Healthcare costs were already overwhelming without adding another expense, no matter how valuable the support might be.

That changed when the Biden administration recognized a critical gap in the healthcare system. In late 2023, new federal regulations acknowledged what families with medical advocates had known all along: having someone knowledgeable by your side fundamentally transforms the healthcare experience. These regulations paved the way for Medicare to begin reimbursing advocacy services starting in 2024.

First Lady Jill Biden championed this change, emphasizing that navigation support shouldn't be a luxury reserved for those with means. "When you have someone by your side who knows the system and is with you every step of the way, it changes everything," she noted when announcing the new billing codes that allow Medicare and other insurers to pay for patient navigation services.

How Medicare Coverage Actually Works

Under these new regulations, Baba's advocacy services are now covered by traditional Medicare across all 50 states. Many Medicare Advantage plans also provide coverage, with additional plans being added regularly as we expand our credentialing.
Here's how it works in practice:

Getting Started: Before you're matched with an advocate, you'll have a brief consultation with a licensed Baba physician—a straightforward conversation that typically takes about 30 minutes and can happen over the phone. During this visit, the physician gathers information about your health situation and needs while our team verifies your insurance eligibility in real time.

No Surprises: Baba bills Medicare and insurance plans directly. You won't receive unexpected bills that haven't been processed through your insurance first. Before your first appointment is even scheduled, our insurance verification process confirms your coverage, so you know exactly what to expect. If you have a remaining deductible for the year, advocacy services will apply toward that deductible before full coverage begins.

What You'll Pay: The majority of Baba members pay little to nothing out of pocket for advocacy services. Your specific costs depend on your individual Medicare or Medicare Advantage plan details, but there are no hidden fees or surprise charges.

Why This Coverage Matters

The American healthcare system has grown increasingly complex—a maze of specialists, insurance requirements, prior authorizations, and fragmented care that even healthy people struggle to navigate, let alone those dealing with serious illness or cognitive decline.

Research consistently demonstrates the value of healthcare advocacy. Having someone who understands the system, can communicate effectively with medical providers, translate complex information into understandable terms, and coordinate care across multiple specialists leads to better health outcomes, reduced stress, and more empowered patients.

Think of it this way: you wouldn't represent yourself in court without a lawyer's expertise. Why should navigating the equally complex healthcare system be any different? A healthcare advocate is like having a nurse in the family—someone who knows how to make the system work for you rather than against you.

Who Benefits From Advocacy Support?

Honestly? Everyone can benefit from having a healthcare advocate, and we hope that eventually every American will have access to this support as a standard part of their care team.

Advocacy is valuable across the full spectrum of healthcare needs:

• Preventative care: Coordinating screenings, understanding test results, and maintaining wellness

• New diagnoses: Making sense of complex information during an overwhelming time

• Chronic condition management: Coordinating multiple specialists and treatments over time

• Major health transitions: Navigating stroke recovery, cancer treatment, or progressive conditions

• Cognitive changes: Providing support when memory or thinking difficulties make self-advocacy harder

The new Medicare coverage recognizes that advocacy isn't a luxury—it's an essential component of quality healthcare, particularly for older adults managing multiple conditions, taking numerous medications, and seeing various specialists.

Checking Your Specific Coverage

While Baba is covered by traditional Medicare nationwide, Medicare Advantage plan coverage varies by specific insurer and plan. We're actively expanding our network of credentialed plans and adding new coverage partnerships regularly.
To find out if your specific plan is currently covered, you can contact our US-based support team at (833) 355-2676. They'll be able to verify your eligibility and answer any questions about coverage details specific to your situation.

The Bigger Picture

This shift in Medicare policy represents recognition of a fundamental truth: the healthcare system has become too complicated for individuals to navigate effectively alone, especially during the vulnerability of illness. Advocacy support addresses this reality by providing the guidance, coordination, and empowerment that transform healthcare from a confusing ordeal into a manageable journey.

As First Lady Biden stated when announcing the new billing codes: "This means that more Americans will benefit from the critical support that patient navigators provide." It's a step toward making healthcare work better for everyone—ensuring that knowledge of the system, ability to coordinate care, and confidence to advocate for your needs aren't privileges, but standard parts of the care everyone receives.

If you're ready to experience healthcare with an advocate by your side—someone who handles the complexity, coordinates your care team, and ensures your voice is heard—Baba is here to help. With Medicare coverage now making advocacy accessible, there's no reason to navigate the healthcare system alone.

This information is for educational purposes and should not substitute for professional guidance. Healthcare coverage details vary by individual plan. Consult with Baba's support team or your insurance provider for information specific to your situation.