Coverage path Original Medicare Medicare Advantage plan Medicare and Medicaid Not sure
Serious illness situation New serious diagnosis or treatment plan Multiple specialists, appointments, or referrals Treatment barriers or social needs Behavioral health, substance use, or mental health need Not sure what qualifies
Navigation status Not discussed yet Offered, decision pending Already active Bill or EOB is confusing
Main barrier to solve Transportation or appointment access Food, medicine access, or cost pressure Language access or confusing instructions Housing, utilities, or home stability Caregiver coverage or family coordination
Caregiver involvement Older adult manages alone Family caregiver helps Long-distance caregiver Paid caregiver, agency, or facility involved
Cost concern Costs not reviewed yet Deductible, coinsurance, or copay question Need low-income or supplemental help Unexpected bill or EOB
Care team map Care team roles are unclear Some contacts, but scattered Coordinated contact list exists
Next call to prepare for Treating clinician or billing provider Medicare or Medicare Advantage plan SHIP or benefits counselor Navigator or care team member Local community resource
Use this before starting or reviewing serious-illness navigation.
Do not enter names, Medicare numbers, Social Security numbers, claim numbers, diagnoses, medication names, account numbers, provider IDs, portal passwords, or private medical records. Keep real care plans, bills, and navigation notes in a secure folder.
This planner is educational and organizational only. It is not medical, insurance, billing, benefits, legal, privacy, tax, or financial advice. Confirm eligibility, cost sharing, plan rules, care-team roles, crisis steps, and local-resource referrals with qualified clinicians, Medicare, the plan, SHIP, or other qualified help.
Official references:
Medicare principal illness navigation services ,
CMS care management services ,
CMS health-related social needs FAQ ,
Eldercare Locator ,
SHIP Medicare counseling .
