Medicare coverage
Does Medicare Cover Principal Illness Navigation?
Yes. Medicare Part B (Medical Insurance) covers principal illness navigation services if you’re eligible.
Yes: Part B
Source: Medicare.gov, Principal illness navigation services, checked October 23, 2026.
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Coverage at a glance
- Covered?
- Yes
- Which part
- Part B
- What you pay
- After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
- Part B deductible 2026
- $283 a year (CMS). Part B premium $202.90 a month.
- Medicare.gov page
- Principal illness navigation services
Description
Principal illness navigation is a type of care management that helps you understand your medical condition or diagnosis and navigate the health care system to find the care providers you need.
From Medicare.gov, checked October 23, 2026.
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.
From Medicare.gov, checked October 23, 2026.
Who's eligible
You must 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
From Medicare.gov, checked October 23, 2026.
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.
From Medicare.gov, checked October 23, 2026.
Costs
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
From Medicare.gov, checked October 23, 2026.
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.
From Medicare.gov, checked October 23, 2026.
Related pages
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Only in certain cases
- Does Medicare Cover Cognitive Assessments?
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Only in certain cases
- Does Medicare Cover Principal Care Management?
Yes
- Does Medicare Cover Transitional Care Management?
Only in certain cases
- Does Medicare Cover Advanced Primary Care Management?
Yes
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Questions
Does Medicare Cover Principal Illness Navigation?
Yes. Medicare Part B (Medical Insurance) covers principal illness navigation services if you’re eligible.
Which part of Medicare covers Principal Illness Navigation?
Medicare.gov lists Principal illness navigation services under Part B.
How much do you pay for Principal Illness Navigation with Medicare?
Per Medicare.gov: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
Does a Medicare Advantage plan cover Principal Illness Navigation?
Medicare Advantage plans must cover what Original Medicare covers and some offer extra benefits. Check the plan's Evidence of Coverage. Rivvi does not recommend plans.
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Does Medicare Cover Principal Illness Navigation?
Yes. Medicare Part B (Medical Insurance) covers principal illness navigation services if you’re eligible.
Checked against Medicare.gov 2026-10-23. Source: Rivvi