Navigating Medicare is no small task. Beneficiaries must choose between Traditional Medicare and Medicare Advantage, decide whether to purchase a Medigap policy, evaluate the costs and coverage of Part D prescription drug plans, and so on. Plus, every Congressional cycle brings changes to the program. Making the “wrong” decision can mean increased care costs or gaps in coverage for beneficiaries – and, for those who are on a lower fixed income or have complex medical needs, challenges to affordable and comprehensive care are intensified. Similarly, the rise of deceptive marketing and misleading advertising of Medicare Advantage plans has only compounded the hurdles Medicare beneficiaries have to face.
To address these challenges, the federal government offers states funding for the State Health Insurance Assistance Program (SHIP). With federal oversight from the Administration for Community Living (ACL), states independently run SHIP counseling centers that provide outreach and education to Medicare beneficiaries, as well as individual counseling to help beneficiaries navigate Medicare’s many caveats. Despite being around for decades, SHIP services are not well known, and little academic work has evaluated their operations, successes, or challenges.
New Research
Evaluators at Boston University School of Public Health explored SHIP service access in a recent paper with Health Affairs Scholar. In it, they investigate SHIP staff members’ experiences providing counseling services to Medicare beneficiaries and potential barriers to SHIP service access.
Data and Methods
Researchers conducted a qualitative study interviewing SHIP coordinators and counselors. To identify potential participants, they randomly selected SHIP sites representing different levels of median household income, urban or rural status, and the number of available Medicare plans. Recruitment was facilitated through the ACL and state SHIP directors, who helped connect researchers and practitioners. Interviews were conducted via Zoom between April and September 2023.
In all, 22 SHIP coordinators and counselors were interviewed across 15 states. Participants offered a diverse mix of backgrounds, experience, and responsibilities within SHIP programs. Coordinators had experience ranging from 6 months to 17 years, with some transitioning from state or county agencies into the SHIP role.
Separate interview guides were developed for coordinators and counselors, and they were reviewed by ACL staff. Coordinators were asked about recruitment and retention strategies for volunteers and staff, while counselors were asked about common beneficiary concerns, particularly those affecting dual-eligible and low-income folks.
Findings
The study found that SHIP services are crucial in guiding Medicare beneficiaries through complex enrollment decisions, particularly for low-income and dually eligible individuals. Persistent challenges limit their impact, however, including staffing shortages, accessibility barriers, and growing complexity of Medicare information and misinformation. Some staff expressed frustration with the complexity of the information within the Medicare system and some indicated they would benefit from additional training, particularly on Medicaid and dual eligibility for Medicare and Medicaid.
Researchers also asked counselors about modes of service delivery and potential barriers to access. Staff report that virtual counseling became more frequent during the onset of the COVID-19 pandemic and is more popular for beneficiaries in rural settings. But, it isn’t a one-size-fits-all solution. Staff report that many beneficiaries, especially those with mobility or transportation limitations, prefer virtual counseling, whereas those without access to technology and/or are dually eligible prefer in-person counseling. Language barriers were common among beneficiary recipients, although most counselors reported satisfaction using a phone-based language-line interpretation service. Counselors did face difficulties, however, with translating Medicare jargon and in cases in which beneficiaries declined to use the translation line.
SHIP staff reported that counseling sessions covered a wide range of topics, with significant attention paid to helping clients understand the differences between Traditional Medicare and Medicare Advantage plans. Counselors helped clients assess their needs based on factors such as health care usage, pre-existing conditions, and financial considerations. Low-income and dually eligible individuals were frequently counseled on Medicaid, Medicare Savings Programs, and low-income subsidies (e.g., the Extra Help program). A key challenge faced by counselors was dealing with misinformation from television advertisements or brokers, which led beneficiaries to make uninformed decisions about their Medicare options.
Limitations
While the qualitative approach provides in-depth insights into SHIP operations and challenges from the perspective of SHIP staff, it does not capture beneficiaries’ perspectives. Similarly, interview participation relied on state SHIP directors for participant referrals, which may have introduced selection bias both in the staff and sites recruited to participate.
Conclusion
SHIPs hold a vital role in guiding Medicare beneficiaries through complex coverage decisions. Counselors frequently combat misinformation from ads and brokers, often assisting with unintended enrollments. Expanding training to include information on Medicaid and increasing paid staff are essential to strengthening SHIP’s ability to provide accurate, unbiased support to those who need it most.
