SHIP counselors can provide free help with open enrollment decisions, enrollment questions, and appeals in every state.
Medicare can be a complicated system. A mistake when signing up could lead to lifelong penalties or coverage gaps, and people who lose their jobs after 65 have an extra layer of complexity. Every Medicare beneficiary can select a Medicare Part D or Medicare Advantage plan during open enrollment each year. The plan you choose could significantly impact your out-of-pocket expenses. Many low-income people aren’t aware that they are eligible for extra assistance to pay for Medicare drugs. You can appeal and fight back if your medication or care is denied. All of these complicated Medicare issues can be handled by your State Health Insurance Assistance Program or SHIP.
What Is SHIP?
Each state administers the program and provides free counseling to help with Medicare questions. The SHIP program is available in every state (as well as in Puerto Rico, the District of Columbia, and the Virgin Islands). Approximately two-thirds of states run the SHIP through the department of aging, and the other third through the insurance department, according to Rebecca Kinney, director of the Office of Healthcare Information and Counseling. Kinney says the company aims to help people understand Medicare, sort through their options, and enroll in the best plans. We aim to help people make the most of their Medicare benefits through one-on-one counseling and public outreach.
About 16,000 SHIP counselors have completed a rigorous training program, explains Ginny Paulson, the director of SHIP’s National Technical Assistance Center, which provides information and training to SHIPs. Half are volunteers, and half work for a government agency or nonprofit. Local support organizations, hospitals, senior centers, senior housing complexes, and area agencies on aging have SHIP-trained professionals. At Cook County Hospital, about 50 counselors are undergoing training under Illinois SHIP, according to the SHIP director at the Illinois Department of Aging, Sandy Leith.
In addition to answering Medicare questions over the phone, SHIP counselors provide seminars and one-on-one sessions to help people make Medicare decisions. Not all states use the name SHIP, California, for example, uses HICAP (Health Insurance Counseling and Advocacy Program), and Florida has SHINE (Serving Health Insurance Needs of Elders). Minnesota uses SHIP money for Medicare counseling. You can find out more about SHIP at www.shiptacenter.org. Call 800-Medicare to find out how to get in touch with your local SHIP.
According to Kinney, the whole purpose of the program is to get people into their communities so they can understand the nuances of Medicare, as the Medicare Advantage plans, Medigap plans, and other pieces of Medicare are highly localized. Because SHIPs can cater to the needs of their communities, they’re so successful.
If you have questions about any level of Medicare, SHIPs can assist you. Paulson says SHIPs are comprehensive – they help with enrolling in Medicare, knowing the enrollment periods, understanding the benefits of Medicare, and the different ways you can access it. They can also assist with Medicare Advantage, Medigap, and Part D questions. She says they can also assist with Medicare out-of-pocket costs and appeals.
Many people do not know about SHIPs, which yearly help thousands of people with Medicare issues. Here are some ways that SHIPs can assist with Medicare decisions and questions.
- Open enrollment help.
- Medicare enrollment questions.
- Special help for lower-income people.
- Medicare problems and appeals.
Open Enrollment Help
Open enrollment for Medicare Advantage plans and Part D prescription drug plans is the busiest time for SHIP counselors from Oct. 15 to Dec. 7. Shannon Hohl, the program supervisor of Idaho’s SHIP program, says that pretty much everyone on Medicare can do something during this time.
There are usually several open enrollment seminars offered by SHIPs throughout their states and one-on-one counseling. If you come to the counselor with a list of your medications, the counselor will search the Medicare Plan Finder to choose which Medicare Advantage or Part D plan will work the best for you.
Due to COVID-19 restrictions, counselors have had to change how they meet, but they still provide personal counseling through Zoom, GoToMeeting, or Webex, where they share computer screens and walk through Plan Finder results together. Additionally, they work with adult children who are helping their parents. Medicare beneficiaries often give counselors permission to log into their MyMedicare.gov accounts and see their last 12 months of drug claims, which can be helpful when comparing plans.
When people aren’t comfortable with technology, counselors can call them, get a list of their medications, and mail them the Plan Finder results showing their premiums and out-of-pocket costs.
During the pandemic, states have also come up with creative solutions to provide one-to-one counseling, says Maggie Flowers, SHIP/MIPPA program manager at the U.S. Department of Health and Human Services Administration for Community Living. Counseling is being offered through drive-throughs in Florida. After preparing the beneficiary in advance, they come up in the car with their appropriate gear and talk about the plan comparison, she says.
A Chicago organization called the Coalition of Limited English Speaking Elderly works with the Illinois SHIP to provide counseling and seminars in other languages.
During open enrollment, it’s a good idea to make an appointment with your local SHIP early to avoid being turned away. They will also post virtual open-enrollment seminars on their websites.
Medicare Enrollment Questions
As part of their services, SHIPs assist with signing up for Medicare. Unless you already receive early Social Security benefits at 65, you must proactively sign up for Medicare. When you’re still working past 65 and have health insurance from your employer, signing up can be complicated, especially if you lose your job and need to make a quick decision.
The gaps in Medicare can also be filled in several ways – with Medigap and Part D prescription drug plans or a private Medicare Advantage plan instead of traditional Medicare. Counselors at SHIP can assist you in assessing the plans available in your area, which can vary by state and county.
Our target age is 64, says Hohl. When people call us, they say they plan to retire next year or will be turning 65, and they want to know what Medicare and health insurance will mean for them. Several seminars are held every year by her office for people who are about to enroll in Medicare (now available online), as well as one-on-one counseling. Those under 65 who are disabled or have other medical conditions and are eligible for Medicare can also receive help from them.
Providing special assistance to low-income families
As well as helping people with their prescription drug costs, SHIP counselors can also help with other programs that may help with their premiums and expenses. Several organizations screen for low-income extra help programs automatically as part of other services, but you can also contact the SHIP to find out if you qualify. If you are struggling with Medicare costs or are concerned about them, Hohl says you should contact us. If they are not eligible for a program, perhaps they could do a plan review and save some money anyway. To ensure Medicare beneficiaries receive the extra help, the SHIP counselors can also assist with recertification paperwork.
Medicare Problems and Appeals
SHIP counselors could assist you if your health care or drug were not covered by Medicare, Medigap, Part D, or Medicare Advantage plans.
If they receive a Medicare Summary Notice (like an explanation of benefits) and something isn’t covered, they can call Medicare, but they can also call us so we can explain. The counselors have special access to the 800-Medicare call center and a unique ID so Medicare knows they’re talking to an expert. With questions, SHIP counselors can also contact Medigap, Part D, or Medicare Advantage plans.
They can identify an error without having to make a formal appeal. Paulson explains that the provider might have messed up with how they coded it. A SHIP counselor has been trained in the appeals process specific to Medicare if they need to appeal a decision.
Medically necessary services, such as mammograms, ambulance claims, surgeries, or other treatments, are covered by HICAPs, whether the beneficiary has original Medicare Part A or B or Medicare Advantage. According to Tatiana Fassieux, education and training specialist for California Health Advocates, a nonprofit organization that advocates for SHIP programs (HICAPs) and resolves client problems through training and advocacy, HICAPs also help with Part D prescription drug coverage denials.