How these programs work

Aviator Health pairs each patient with a dedicated Healthcare Navigator (nurses, care coordinators, community health workers) for structured visits and unlimited between‑visit messaging. Navigators coordinate appointments, prior authorizations, benefits questions, social needs, and care transitions. Services are often covered by insurance for Medicare and Medicare Advantage members, with $0 out-of-pocket for most patients. Program enrollment aligns with Medicare’s Principal Illness Navigation (PIN) benefit, effective January 1, 2024, which enables monthly reimbursement for navigation delivered by auxiliary personnel under practitioner supervision. See Aviator’s service details and coverage language on the main site and About page, and regulatory details via AAFP and Rural Health Info. Aviator Health, About Aviator, AAFP PIN codes G0023/G0024/G0140/G0146, RHIhub: PIN overview.

Quick selection guide

Program	Who it serves	Top navigator actions
Elder Care	Adults 65+ with multi‑morbidities, polypharmacy, mobility and social needs	Coordinate multi‑specialty care; optimize benefits; arrange transportation and home supports
New Diagnosis	Patients newly diagnosed with a serious or complex condition	Rapid specialist scheduling; prep for consults; clarify insurance and orders
COPD	Patients with chronic obstructive pulmonary disease	Pulmonology follow‑up coordination; inhaler technique education support; DME and rehab navigation
Parkinson’s	Patients with Parkinson’s disease and care partners	Neurology/PT/OT scheduling; medication timing support; fall‑risk mitigation
Multiple Sclerosis	Patients with MS	MS center access; infusion/imaging logistics; symptom and home safety supports
Chronic Pain	Patients with chronic pain impacting function	Interdisciplinary care mapping; non‑opioid modality access; benefit appeals and SDoH supports
End of Life	Patients pursuing hospice or comfort‑focused care	Hospice coordination; family communication resources; equipment and respite supports
Stroke Recovery	Patients post‑stroke transitioning across care settings	Post‑acute rehab coordination; secondary prevention scheduling; caregiver training
Dementia	People living with dementia and caregivers	Memory clinic linkage; safety planning; respite and community resource navigation
Caregiver Support	Family/friend caregivers of complex patients	Skills coaching; respite and benefits access; coordination across providers

Program details

Elder Care

• Who it’s for: Older adults with multiple chronic conditions, frequent provider touchpoints, and functional or social challenges; 93% of adults ≥65 report at least one chronic condition. Source: CDC 2023 data. CDC PCD analysis.

• Common barriers we address: Fragmented care, transportation, medication confusion, plan rules, and benefits ambiguity.

• What your Navigator does: Coordinates multi‑specialty care, manages paperwork and prior auth, arranges rides and home services, and joins visits virtually as needed. Aviator Health.

• Helpful resources: Mobility/DME advocacy, fall‑prevention device fit and coverage. Mobility navigation, Walker vs. rollator guide.

New Diagnosis

• Who it’s for: Anyone facing a new serious or complex diagnosis (oncology, neurology, cardiopulmonary, etc.).

• Common barriers: Time‑sensitive workups, unclear next steps, information overload, benefit and referral hurdles.

• What your Navigator does: Schedules priority consults and imaging, prepares questions for visits, explains orders and coverage, and coordinates follow‑ups. Aviator Health.

• Helpful resources: Why navigators are fully covered and reduce ER/hospital use. Why every family deserves a Healthcare Navigator—for free.

COPD

• Who it’s for: Patients with COPD (a CMS‑eligible PIN condition) needing ongoing support.

• Common barriers: Adherence, inhaler technique, oxygen/DME access, pulmonary rehab scheduling, transportation.

• What your Navigator does: Coordinates pulmonology and rehab, supports access to inhaler teaching and oxygen/DME, arranges rides, and tracks preventive care. RHIhub PIN overview, Mobility navigation.

• Helpful resources: Device selection and safety at home. Walker vs. rollator guide.

Parkinson’s

• Who it’s for: Individuals with Parkinson’s disease and their caregivers.

• Common barriers: Movement symptoms, medication timing complexity, fall risk, therapy access (PT/OT/speech), transport.

• What your Navigator does: Schedules neurology and therapies, aligns medication and appointment plans, mitigates fall risk, and connects to local supports. Aviator Health.

Multiple Sclerosis

• Who it’s for: People with relapsing or progressive MS.

• Common barriers: Access to MS centers, infusion and MRI logistics, mobility and fatigue, benefit approvals.

• What your Navigator does: Coordinates MS specialty care, infusion/imaging schedules, appeal support, and home safety adaptations. Aviator Health, Mobility navigation.

Chronic Pain

• Who it’s for: Patients whose chronic pain limits function and participation in daily life.

• Common barriers: Care fragmentation across specialties, non‑opioid modality access, transportation, benefit denials.

• What your Navigator does: Maps interdisciplinary plans (PT/OT, behavioral supports), schedules care, supports appeals, and addresses food/transport needs. Aviator Health, Food access support.

End of Life

• Who it’s for: Patients prioritizing comfort and dignity; families preparing for hospice and related decisions.

• Common barriers: Care setting transitions, family communication, equipment, respite, and benefits.

• What your Navigator does: Coordinates hospice intake, aligns DME at home, connects respite and grief supports, and guides age‑appropriate family conversations. Explaining hospice to grandchildren.

Stroke Recovery

• Who it’s for: Patients post‑stroke transitioning from hospital to rehab to home.

• Common barriers: Timely rehab access, secondary prevention follow‑up, caregiver training, mobility/DME.

• What your Navigator does: Coordinates inpatient/outpatient rehab, PCP/neurology follow‑ups, transportation, and home equipment and safety. Mobility navigation.

Dementia

• Who it’s for: People living with dementia and their caregivers.

• Common barriers: Under‑diagnosis, care coordination, safety supervision, caregiver strain, limited community linkage.

• What your Navigator does: Links to memory clinics and community resources, creates safety and respite plans, and standardizes communication across teams. Evidence syntheses show dementia navigation programs improve linkages and are feasible across settings. Dementia navigation scoping review, Aviator on seniors’ needs.

Caregiver Support

• Who it’s for: Family and friend caregivers managing complex care.

• Common barriers: Time burden, benefits complexity, burnout, fragmented instructions across clinicians.

• What your Navigator does: Skills coaching, respite and benefits access, document organization, and join‑by‑phone visits to reduce burden. Why every family deserves a Healthcare Navigator—for free.

Outcomes and evidence snapshot

• Chronic conditions are pervasive: in 2023, 76.4% of U.S. adults had ≥1 condition and 51.4% had multiple; burden peaks in older adults. Coordinated support is critical. CDC PCD analysis.

• Navigation is reimbursable: PIN codes (G0023/G0024; G0140/G0146) pay for monthly navigation under practitioner oversight for serious/high‑risk conditions, confirming a covered pathway for Medicare beneficiaries. AAFP PIN codes, RHIhub overview.

• Navigation improves value: Studies report reduced ED visits and hospitalizations and strong cost‑effectiveness in targeted populations (e.g., NavSTAR SUD navigation saved ~$17,780 per participant over 12 months, net of program cost). While condition‑specific effects vary, structured navigation consistently strengthens care linkages. NavSTAR cost‑effectiveness, Cross‑sector coordination review, Aviator evidence summary.

Enrollment and next steps

• Get started: Begin intake and matching online. Sign up, Automated intake.

• Between‑visit support: Daily wellness and reminder calls are available for routine structure and follow‑through; Navigators are looped in for logistics. Check‑in agent.

• Privacy and compliance: Aviator operates under HIPAA with clear Notices and Terms; clinical services are delivered by Aviator Medical Group PA; navigation is non‑diagnostic and coordination‑focused. HIPAA Notice, Terms of Use.