Jack Hoadley, Beth Fuchs, and Rachel Schmidt
The authors have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers can call for unbiased assistance choosing among Medicare options. In this blog series the authors share thoughts on the role SHIPs play in counseling beneficiaries. The authors thank Madeline McBride, who was a George E. Richmond Fellow at the Center on Health Insurance Reforms (CHIR) at Georgetown University’s McCourt School of Public Policy, for valuable research for this post.
In April, a draft of potential spending changes proposed by the Office of Management and Budget for the Department of Health and Human Services (DHHS) budget was leaked. The draft detailed significant budget cuts and agency restructuring, including the elimination of more than $55 million in discretionary funding for the State Health Insurance Assistance Program (SHIP). The SHIP program was created by Congress in 1990 to provide free, impartial information, counseling, and other forms of assistance to current and future Medicare beneficiaries. Consumers can call their local program for help choosing among the complex array of Medicare options and for navigating the Medicare program more generally.
Our perspective on SHIPs reflects professional careers working on Medicare policy, further informed by our more recent experiences as volunteer SHIP counselors. Spending part of a day each week talking to current Medicare beneficiaries or those about to be eligible for the program has given us rich insights into both the value of Medicare and the program’s complexity. SHIP counseling sessions can be lifelines to seniors and those with disabilities who are confused or stymied about how to enroll, whether to enroll in traditional Medicare or Medicare Advantage (MA), which drug plan to select, whether they can qualify for financial help in paying for their health care or their medications, or how to navigate the appeals process. Counselors also educate beneficiaries about fraud and abuse.
The value of SHIP is especially obvious when individuals eligible for Medicare are trying to decide among traditional Medicare, Medigap plans, MA plans, and Medicare Part D drug plans. SHIP counselors are vital resources, especially in an environment saturated with aggressive insurance company marketing and insurance brokers who may be giving advice in line with their personal financial motivations rather than a beneficiary’s best interests.
Federal SHIP funding is distributed to states by the Administration for Community Living (ACL), an agency within DHHS that has been designated for elimination in the proposed DHHS reorganization. ACL allocates grants to states, which in turn support more than 2,000 community-based organizations that administer the program locally. Many states have branded their programs with state-specific names, such as the Virginia Insurance Counseling and Assistance Program (VICAP). Last year, state grants averaged $945,665; in some cases, funding is bolstered by additional state dollars. Between April 2022 and March 2023, around 11,500 SHIP counselors, half of whom were volunteers, provided community outreach and education to over 2.6 million people, and individual assistance to over 1.65 million Medicare-eligible individuals and their caregivers. SHIP counseling calls vary widely from quick answers for basic questions to detailed counseling sessions; call lengths averaged 33 minutes in recent years, representative of the personalized and detailed guidance that these counselors provide.
Not all SHIP counselors have spent their careers working on Medicare like we have. Other counselors may have worked in other parts of the health care system where they learned a lot about Medicare. Still others were educators, social workers, lawyers, or executives, who are willing to invest their time to get the credentialing and Medicare training needed to help prospective and current Medicare beneficiaries or their family members or caregivers.
The two most common types of help we provide in our counseling sessions come from clients who are new to Medicare and those using the program’s annual enrollment period. For example, people often call the SHIP phone lines or visit SHIP offices when they are soon to turn 65, become eligible after receiving disability benefits for two years, or are approaching retirement from a job that provided their health insurance. Or sometimes it is the beneficiary’s spouse, adult child, sibling, or friend who calls. Our clients want to learn the mechanics of enrolling in the program, understand how traditional Medicare differs from MA, hear about their options for supplementing Medicare, and more. As counselors, we are careful to listen to their concerns and to avoid responses that are biased in any particular direction.
During Medicare’s fall annual enrollment period, we sometimes hear from beneficiaries who have learned that their current plan is being discontinued. Medicare Advantage organizations or Part D plan sponsors generally propose to switch them to another of the organization’s plans, but sometimes it turns out that the beneficiary will save a lot of money by looking at other alternatives. We also hear from beneficiaries who would like to find out if their current plan choices are still the best options. In the fall of 2025, the Inflation Reduction Act’s changes to the Part D prescription drug benefit made it particularly important to check for alternative options. Other beneficiaries reach out because they want to switch to different MA plans, consider returning to traditional Medicare from MA, or try an MA plan for the first time. Providing this help often means an extended phone session where we enter the details of the client’s current prescriptions and other information into the Medicare Plan Finder and then tell them the two or three best Part D plans for their particular situation.
Beyond these two most common types of clients, calls come in throughout the year with more specialized requests. Over the past year, we have heard many different stories and requests for help.
- A daughter calling about whether her parents, newly moved to the US from overseas, can get coverage from Medicare.
- A woman calling to say that her sister (who has dementia) just qualified for Medicaid and wants to know how that will interact with her sister’s existing coverage from both Medicare and Tricare.
- A son who wants to understand why his mother, who is getting rehabilitation care after a hospital stay, has received a notice that her MA plan will no longer cover the post-hospital care and wants to know whether they can appeal that decision.
- A beneficiary, who has just moved from another state where she was enrolled in an MA plan, wants to know what her options are in her new home state.
- A daughter reporting that her father will be going into assisted living and has been told that the facility’s providers don’t participate with her father’s MA plan.
- A beneficiary who has been prescribed an expensive medication that is not on her current plan’s formulary and cannot afford to fill the prescription.
- A newly eligible beneficiary, about to retire from a job that comes with retiree health benefits, wants to know how that coverage would work with Medicare or whether it makes sense for him to elect to enroll in Part B.
- A newly eligible beneficiary is tilting towards enrolling in traditional Medicare and wants to learn about Medigap options.
As counselors, we try our best to find the answers to their questions. It sometimes means an hour on the phone, asking questions and then leading the client through their options. Even those of us who have studied Medicare policy for decades may find that we don’t know the answers to certain questions, but at least we know how to research the answers. Of course, sometimes there is no good answer. At the very least, we put forward some ideas, offer patience in listening to their concerns, and give them guidance. The client gets off the phone, usually with answers or next steps to take, and we hope they feel like their concerns have been heard by a friendly ear. In the words of one recent client, “Before speaking to you, I felt overwhelmed by the whole process. With your help, I’ve gotten a much better understanding and feel more confident about proceeding with my application.”
While the Administration’s proposed budget cuts to the SHIP program would leave around $15 million in annual mandatory funding, the roughly 80 percent funding reduction would certainly reduce the capacity of the program, which has already been operating on years of flat funding, to provide essential services to Medicare beneficiaries and their families. Perhaps some states or communities would step up to replace the lost federal funds if the cuts are made, but inevitably many local SHIPs would be scaled back and many would be eliminated. Although many counselors are volunteers, federal funds pay for the infrastructure, training, and administration needed to support the program, including the cost of local advertising, managing a website, and making presentations at community events. The federal Medicare call center (1-800-Medicare) would presumably remain, but it simply cannot provide the kind of in-depth problem solving that SHIP counselors provide. Nonprofit organizations such as the Medicare Rights Center and the Center for Medicare Advocacy will continue to be available as valuable resources, but they would be challenged to pick up all the clients now helped by local SHIPs.
One of the features that makes the SHIP program unique is its local focus. Counselors are based in a local county program office. As a result, we know the landscape of our community: the MA and Part D plans that operate there, the prominent hospitals and physician groups in the area, and other health, social and other resources provided by the county. That level of help cannot be provided by Medicare’s call center. Furthermore, SHIP counselors must be neutral and unbiased. We do not tell clients that MA is better than traditional Medicare or vice versa; instead we lay out the pros and cons. In shopping for a client’s Part D or MA plan, we consider all options equally, unlike a broker who may receive compensation from just a subset of Medicare Advantage organizations and may not mention all available options.
Because SHIPs rely heavily on volunteers, they are a true bargain—a very small drop in the large bucket of federal dollars spent on health care. Preserving that investment to provide Medicare beneficiaries with an unbiased source of information and advice about their Medicare choices should be an easy decision.