State Health Insurance Assistance Program Provides Valuable Guidance to Medicare Beneficiaries, but Many Don’t Know It Exists

Choosing the right Medicare option becomes more challenging every year. There are growing numbers of coverage options for beneficiaries to review, as well as a deluge of advertisements, including some deceptive ads. During Medicare open enrollment (October 15 through December 7 this year), beneficiaries also must be alert to the possibility that their insurance broker or agent is making a recommendation driven by their own financial interests and in response to commission incentives. The federal government recommends beneficiaries seek information and support from the State Health Insurance Assistance Program (SHIP).

SHIP is administered by the Administration for Community Living, which provides grants to states, which in turn provide subgrants to organizations, including Area Agencies on Aging (AAAs). These organizations use paid and volunteer counselors to supply free education, outreach, and counseling on Medicare coverage options. However, only one of 20 Medicare beneficiaries report using a SHIP to guide coverage decisions. To better understand how beneficiaries learn about SHIP - and ultimately to increase use of these services - we interviewed SHIP staff about their experiences providing counseling services to beneficiaries. We asked 13 SHIP coordinators how beneficiaries first encountered SHIP counseling services.

Beneficiaries Referred by Word of Mouth and Government Agency

More than half of SHIP coordinators said beneficiaries learned about the SHIP program via word of mouth through their social networks and from referrals from government agencies that provide benefits or social services. These included referrals from Social Security offices, AAAs, county assistance offices, state departments focused on older adults or health services, and state marketplaces.

Coordinators said beneficiaries learn about SHIP by attending community outreach events, including educational sessions conducted by SHIP staff about Medicare, senior expos, and sessions conducted jointly with other community organizations. One coordinator said community events helped them reach individuals who are less tech-savvy and stated: "We're trying to reach the people who have a hard time reaching us or don't even know we exist . . . by partnering with other community organizations and community-led organizations in the state." Coordinators said beneficiaries also learned about SHIP through its social media posts and SHIP and affiliate websites. Brochures, flyers, and hospital or human resources referrals were mentioned less frequently. Paid advertisements were rarely mentioned.

Our findings align with an evaluation of California's Health Insurance Counseling and Advocacy Program, California's SHIP, which found that most beneficiaries learned about the program via word of mouth, community outreach, referrals from service providers, and online searches.

Community Outreach Necessary but Not Sufficient

State SHIPs are evaluated on the frequency of their community outreach, but although outreach is integral to building trust with communities, it may not be enough to build large-scale awareness.

Word of mouth and agency referrals - cited by coordinators as the most common ways beneficiaries were made aware of SHIP - rely on existing relationships and interactions. In more than two-thirds of states, AAAs are involved in providing SHIP services or coordinating with local organizations to provide SHIP services. However, awareness of AAA services is also limited.

New Medicare Regulations May Improve Awareness

Medicare regulations stipulate that third-party marketing organizations, including agents and brokers, tell beneficiaries about Medicare.gov, 1-800-Medicare, and SHIP. The requirement to mention SHIP was new for contract year 2024 and its effects should be monitored.

Consistency in Naming Could Help

Names of SHIPs vary across states and several states do not include the word "SHIP" in the title. This may be confusing to beneficiaries who have been directed to seek SHIP services. In addition, potential clients may not be aware of the difference between brokers and SHIP counselors. Consistency in naming and branding may facilitate communication of both the existence and features of SHIP.

National Communications to Promote SHIP Services

SHIP may be able to draw on lessons learned from marketplace plans. Federal health insurance navigators reported that, before 2017, national advertising was useful in making connections with potential enrollees and for increasing enrollees' baseline insurance knowledge. In addition, public information campaigns have been associated with increased enrollment in marketplace plans. Although there have been state public service announcement initiatives about SHIP, there has not been a systematic national campaign.

There are also opportunities to increase the salience of SHIP information in existing beneficiary communications. The Medicare & You handbook (i.e., the official Medicare guide) includes SHIP contact information - but not until page 114. In addition, all beneficiaries receive a Medicare card, which provides 1-800-Medicare and Medicare.gov resources - but not SHIP.

Systematic communications, coordinated at the federal level, may supplement word of mouth, agency referrals, and community outreach events to improve awareness of SHIP, facilitating interactions that can combat misinformation about Medicare coverage options. Assuming they are effective, efforts to increase awareness of SHIP services should be accompanied by funding to ensure support for an adequate number of counselors to meet demand.