State Health Insurance Assistance Programs (SHIPs) help people understand Medicare, Medicaid, and state and federal assistance programs for seniors. These programs are complex, and people often need help understanding the programs and coverage that can help them with their needs. Every state has a State Health Insurance Assistance Program, which is a free resource to help people learn how to make the most of these programs. Here, we’ll explain what SHIPs do and how they can help you understand the insurance and financial options that are available to you that can help cover living expenses and medical costs.
SHIP was created through the Omnibus Budget Reconciliation Act of 1990. Under this law, the Centers for Medicare and Medicaid Services was allotted money to create health insurance advisory programs in every state and U.S. territory. States may refer to their programs differently, but each state has one.
SHIP’s main purpose is to ensure that Medicare-eligible seniors understand the benefits they might have access to and to educate seniors, their families, and their caretakers about how to start receiving Medicare benefits.
What services do State Health Insurance Assistance Programs provide?
SHIP offers Medicare counseling to people who are or soon will be eligible for Medicare. Family members and caregivers can use SHIP services to help their loved ones understand how to apply for Medicare and receive health insurance coverage.
SHIP counselors are trained to assist Medicare beneficiaries. Every counselor is required to participate in an extensive 8-to-10-hour training process. SHIP counselors have been trained to help seniors understand different components of Medicare, including:
- How to enroll in Medicare benefits.
- Medicare terms and options for coverage.
- What Medicare does and does not cover.
- The ins and outs of Medicare Parts A, B, C, and D, Medigap, and other supplemental insurance benefits.
- Medicare enrollment penalties.
- The appeals process.
- Medicare Savings Programs.
- Extra Help (or Low-Income Subsidy) program.
- Long-term care insurance coverage options.
Depending on your need, a SHIP counselor might refer you to Medicaid offices or the Social Security Administration to pursue additional benefits.
SHIP counselors also participate in outreach programs that notify people who could potentially benefit from the service. SHIP outreach programs can include:
- Community events.
- Health fairs.
- Senior fairs.
- Informative presentations to seniors, their families, and their caregivers.
What State Health Insurance Assistance Programs can’t do
SHIP offers counseling about health insurance, but it does not offer medical insurance coverage. Working with SHIP does not mean you are enrolling in a health insurance program. SHIP also does not enroll seniors in Medicare. SHIP’s services are limited to helping seniors and their caretakers understand Medicare and their options for health care coverage.
When to use your State Health Insurance Assistance Program
SHIP was established to assist seniors who are approaching a significant milestone in their lives. Many people who use SHIP’s services are at retirement age and need to understand their options for health care coverage. Below are a few scenarios in which you might benefit from the services SHIP offers.
Getting help with Medicare open enrollment
The Medicare open enrollment period (which runs annually from October 15 to December 7) can be confusing for someone applying for Medicare. SHIP counselors offer help by hosting seminars where seniors and their families can get individualized counseling and answers to their questions.
Appealing a Medicare denial
SHIP helps seniors understand their right to appeal a Medicare denial. Not complying with Medicare appellate procedures can result in you losing your right to receive benefits. SHIP can connect you with a trained counselor who can provide one-on-one counseling services if you find yourself in the appeals process.
Getting financial assistance
Lower-income seniors might have special offers regarding Medicare enrollment. Depending on your income, you might be eligible for the Extra Help program from Medicare to help pay for prescription drugs, for example. A SHIP counselor can evaluate the situation and help you determine if you are eligible. SHIP can also help with any recertification paperwork.
Prepare to meet with your State Health Insurance Assistance Program counselor
When you speak to a SHIP counselor, they will need some personal information to best serve you. Before contacting a SHIP counselor, be prepared with the following information to get the most out of your initial meeting:
- Medical conditions and medical history.
- Prescription medications.
- Income and asset information.
- Medicare card (if you are currently enrolled).
- Information about other health insurance you might carry.
How to find your local State Health Insurance Assistance Program
SHIP offices are located in all U.S. states and territories, including Puerto Rico, Guam, the U.S. Virgin Islands, and the District of Columbia. The official name for your area’s SHIP services may differ. You can find a local SHIP counseling service by visiting shiphelp.org. Click on “Find Local Medicare Help” in the top right corner and follow the link to the office in your state or U.S. territory. You can also get help finding your local SHIP by calling the national hotline at 1-877-839-2675.
Understanding your health insurance options and services can be difficult, as the topics are complex. State Health Insurance Assistance Programs are there to get you help with the nuances of Medicare and other resources that may be available to you. With the help of trained counselors, you can be sure you are making the most out of these resources.
