Although Medicare can be complicated and sometimes maddening, there is a little-known cadre of free, unbiased Medicare experts who can help you wade through the system. You can find them at State Health Insurance Assistance Programs, or SHIPs.
Congress created the national, federally funded SHIP system for Medicare advisory assistance in 1990. SHIPs are now run by the Federal Administration for Community Living (ACL) agency, part of the U.S. Department of Health and Human Services.
What Medicare SHIP programs offer
“The purpose of SHIP is to help Medicare beneficiaries navigate Medicare and understand how it works to make informed decisions on their Medicare plans and to troubleshoot and provide any assistance needed,” says Rebecca Kinney, director of the Office of Healthcare Information and Counseling at ACL.
Its advisors are local staffers and volunteers trained and certified to provide one-on-one counseling to new and existing Medicare beneficiaries about Medicare Part A (hospital insurance), Medicare Part B (doctor bills and home health care), Medicare Part C (private Medicare Advantage plans that are an alternative to Traditional Medicare Parts A and B), Medicare Part D (prescription drug plans), and Medicare Supplement or Medigap plans.
“Some counselors may be Medicare beneficiaries themselves, which gives them personal experience with the situations others are going through,” says Susan DeMarois, director of California’s Department of Aging.
Each year, SHIP advisors assist more than 2.6 million Medicare beneficiaries, their families, and caregivers.
What SHIP counselors won’t do
These experts won’t tell you which Medicare plan to get—they’re not allowed to—but they will help you figure out how to make that decision wisely.
By contrast, Medicare brokers are paid by health insurance companies to sell Medicare Advantage, Medigap, and Part D plans.
SHIP programs go by different names in different states. Sometimes, as in California and New York, they’re known as Health Insurance Information Counseling and Assistance Programs or HIICAP. You can find your state’s program by using the federal SHIP Locator or by calling the toll-free SHIP number, 877-839-2675.
Why people might want to use a SHIP Program
People ready to enroll in Medicare contact SHIP plans for many reasons—the process can be overwhelming, and it’s good to have some unbiased support. Among the most popular reasons:
- They want help deciding between Traditional Medicare and Medicare Advantage plans and among Part D plans. “We try to break it down in a way that allows them to really understand what the choices are so they can feel more confident in the decision,” says Kinney. “Once the decision is made, we can help with the enrollment.” These complicated conversations can take over an hour, or last for more than one session.
- They’re looking for advice on keeping prescription costs down. “They’ve gone to the pharmacy and have been presented with a co-pay for a prescription drug that’s very high and they think to themselves, ‘Hey, I can’t afford this. I really don’t have the money,’” says Heather Leddick, coordinator of New York’s HIICAP plan.
- They’re eager to learn about Medigap plans or the services Medicare covers, says DeMarois. Some wonder whether they should consider getting a Medigap plan to supplement Traditional Medicare or sign up for a Medicare Advantage plan. Some don’t know what Medicare does and doesn’t cover; the Medicare.gov site can tell them, as can this Fortune article.
- They’re confused about Medicare bills they’re received, why some costs weren’t covered, or how to appeal a claim denial. “People get kind of held up when it comes to claims and billing issues and appeals,” says Leddick.
The volunteers at your local SHIP office should be able to address all these questions and more.
SHIPs can advise on state programs to save on health costs
Maggie Flowers, the SHIP/Medicare Improvements for Patients and Providers Act Program Manager at ACL, says SHIP counselors can explain, too, whether you qualify for a state’s low-income subsidy program for prescription drug costs (also known as Extra Help) or its Medicare Savings Program, which helps pay Medicare Part A and B out-of-pocket expenses.
Every state has its own eligibility requirements for the low-income subsidy and Medicare Savings Programs, with varying income, and sometimes asset, limits.
SHIP counselors may also provide screening and application assistance for these programs.
The busy season for SHIP counselors
SHIP advisors are busiest during Medicare’s annual Open Enrollment season, which runs from mid-October through early December. Think of that time as the SHIP equivalent to tax season for accountants.
“At the end of the calendar year, it can get a little bit hard to find an appointment,” says Kinney.
The annual Medicare Advantage Open Enrollment season, which runs from January through March—when people can switch between Medicare Advantage plans or to Traditional Medicare—is busy for SHIP counselors, too. But it’s generally not nearly as hectic as the overall Open Enrollment season.
How to prepare for a SHIP conversation
Before calling a SHIP counselor, it’s helpful to have a list of your prescription drugs, your doctors and nearby hospitals as well as information about the health coverage you currently have.
When you call, you may be able to speak with someone over the phone immediately. Or you can make either an in-person or phone appointment.
“Many times, I’ve sat down with individuals, and they’ve come in with one question. We get into it and realize there’s something else they didn’t realize, because Medicare is so complicated. And we end up going in a different direction,” says Kinney. “That’s okay, as long as in the end we’re able to provide a better understanding and access to Medicare benefits. Then, it’s a win.”
