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State Health Insurance Assistance Program (SHIP) – Medicare SHIP: State Health Insurance Counseling & Assistance

SHIP is the acronym for the State Health Insurance Assistance Program. It is in the service of providing all listed Medicare beneficiaries with necessary enrollment assistance, information, and counseling. Its primary mission is to reinforce the ability of its grantees so that they can support a community-based and grassroots network of all locally based SHIP offices assisting beneficiaries with their questions related to Medicare.

The SHIP came into existence vide the provisions of Section 4360 of the OBRA or Omnibus Budget Reconciliation Act, 1990. This law authorized all Medicaid & Medicare Services Centers to make certain grants to the states for establishing and maintaining programs related to health insurance advisory services for all Medicare beneficiaries. The first program was started back in 1992 for the provision of one-on-one counseling and free and objective information on health insurance to Medicare beneficiaries.

What is SHIP?

These grant funds were given to support information collation and disbursement, assistance and counseling assistance activities that relate to Medicaid, Medicare, supplement insurance for Medicare, insurance for long-term care and also options for managed care. In 2014, vide the provisions of the Consolidated Appropriations Act, SHIP came to be transferred from the CMS to ACL. The said transfer reflected the existing informal and formal collaborations between all programs of the SHIP and the ACL networks.

Where Are They Located?

Many SHIPs base themselves locally or get into partnerships with Area Agencies that work on aging. Nearly 50 % of SHIPs are co-located with the SMP or Senior Medicare Patrol program, which is also under the administration and ambit of the ACL. The State Health Insurance Plan is the insurance program that is used by the people of the state when they do not have private insurance. They are given services that have a wide range of options, and they are given counseling when they do not know what to use. The branch that offers State Health Insurance counseling assistance will talk someone through any decision that they need to make regarding their medical care, dental care, vision care, or mental health care. The counseling team tells people how to use their plan, and they point people in the right direction of every service that is required.

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The Structure of SHIP

Overall 54 SHIP grantees exist and these include all states, Guam, Puerto Rico, US Virgin Islands and the District of Columbia. The Program covers more than 3,300 local SHIP entities and has on its staff over 15,000 counselors, nearly 57% of whom are highly qualified and trained volunteers. 66% of the SHIP’s programs fall under the State Units on Aging while the rest come under the State Departments for Insurance.

How Do Medicare and SHIP Work?

The main work of SHIP is presenting and distributing information to individuals and groups on their available Medicare benefits, forms and written notices, rules on their appeal rights and procedures involved for appeal. Provision of free and in-depth insurance counseling and assistance coverage to all listed and qualified Medicare beneficiaries, their friends, families, and caregivers are also another important item on the State Health Insurance Assistance Program’s working agenda. The local offices of the SHIP assist their members in the following ways:

  • Obtain coverage through multiple options including the original program of Medicare, Plans pertaining to Part C of Medicare Advantage, Part D of Medicare Prescription Drugs Plans, and other programs that help those with limited or lesser incomes to pay for healthcare like Low-Income Subsidy, Medicare Savings Program, and Medicaid.Image result for state health insurance assistance program illustration
  • Help people compare insurance policies floated by Medicare Supplemental and explain in details how these are also other insurance options that are supplemental for retirees work in tandem with Medicare.
  • Provide information on insurance that’s long-term care related and as when required, refer such beneficiaries to specific agencies like the Social Security Administration as local offices of Medicaid for any additional assistance.
  • Providing SHIP counselors trained in navigating systems for old and/or physically challenged people.
  • Events pertaining to Public and Media have increased from 57,041 in 2005 to 87,262 in 2013.
  • Client contacts have increased from 1,246,441 in 2005 to 2,891,784 in 2013. In terms of one-on-one counseling, SHIP reached out to 2.6 million Medicare beneficiaries in 2013.
  • Inquiries in excess of 1,545,000 were received on one-on-one counseling, complaints on an error, potential fraud or abuse were received from beneficiaries and their caregivers and families in 2013,
  • The SHIP educated nearly 5.3 million people by way of media and public campaigns in 2013.

Benefits of SHIP:

  • Medicare beneficiaries get counseling on health coverage at a local level fee.
  • All SHIP members get free education, advocacy, counseling, and empowerment to make informed decisions on healthcare benefits. Moreover, since SHIP happens to be an independent program that is federally funded agency and owes no affiliation to the insurance industry whatsoever, it is acknowledged and accepted as a free-of-bias and fair entity.
  • Any sort of counseling is available for free. Counselors are readily available as are local workshops and presentation for all beneficiaries to attend to get counseling.
  • SHIP is also known as GeorgiaCares, CLAIM, HICP, HICAP, MMAP, I-CARE, SHIBA, Sage Plus, SHIINE, SHICK,

The CHOICES Program, SHIP, and WSHIP in different states.

What is Special about SHIP Counselors? Your SHIP counselor will be someone from your own community who has volunteered as a counselor and is trained in concepts like Medicare options and benefits, eligibility, counseling on health insurance and other related insurance services and products. They are not on the payrolls of any insurance companies and cannot sell insurance products or give legal advice. They are not decision makers either, but will objectively assist and empower you to make some very prudent decisions on your health care.

Associated Information

SHIP events are usually held in all communities on Mondays and these are called Medicare Mondays. The programs have workshops where attendees can get to know about their health care options for the next year. It also bares in mind that Medicare has its own specific periods of enrollment and should you wish to change your Medicare health services, then you need to be present at an event in order to be informed about your choices. Drug and health plans pertaining to Medicare change annually in terms of coverage, cost and the inclusion of pharmacies and providers in their networks. The time period is between the 15th of October and the 7th of December when all Medicare beneficiaries can make changes to their Medicare plans and coverage for prescription drugs for the forthcoming year to suit their needs better.

State Health Insurance Counseling Tips

State Health Insurance Plan counseling is a major part of how the public uses services they have been offered by the state. Someone who is unsure how to use these services could call or email at any time, and they can have a chat with a state health insurance counseling assistance associate. The associates are there to offer practical advice to everyone who calls, and they help people who simply do not understand how insurance works.

They Help In Minor Emergencies 

You might have asked yourself, “what is Medicare SHIP?” This program serves you regardless of the medical or mental condition you must deal with. However, you might not know which part of the program you need to use. Calling for assistance allows you to figure out which part of the program you must engage with. You are probably wondering how you would get in contact with certain divisions of the SHIP, and you might not be aware of the numbers you need to call. Minor emergencies can be worked out quickly when you have spoken to a State Health Insurance counseling assistance team member. They can tell you exactly what to do, and you can make another phone call.

They Make Referrals

There are people out there who simply cannot go from doctor to doctor to get referral after referral. They can not make it to many appointments, and they might not have a chance to go through the few different appointments that are needed to get to the right person. The assistance program makes the appointment for you in many cases, or they could get you on the phone with a doctor’s office to figure out what to do next.

They Explain Extra Services Related image

SHIP is there to help you receive extra services that you have not heard of before. There are those on the plan that could get an affordable cell phone, and there are others that will want to use the service because they need help with their energy payments. These are all little things that get tied to the program, and anyone could call for assistance with these items.

Making Changes To The Plan 

Someone who wonders, “what is Medicare SHIP,” might not know that they have a chance to change their plan if their circumstances change. They could have a child, adopt a child, or have a child move out of the house. People get divorced, and people die. The customer can call the counseling office at any time to make quick changes to their services, and they could get a list of options for choosing their provider.

Choosing The Provider

The provider that people choose helps them get specific services from specific doctors. They could choose a network that they are most happy with, and they could ask about people who are listed on the network. They often need to know how far that network extends, and they could request literature that explains all the plans that are offered. These simple provider questions are handled much faster with someone on the phone, or the user could send an email to get a long-form response.

How Do You File Claims?

Filing claims are easier when you know the process. All the claims that you file are handled by the state, and the state will pay out to your doctor’s office faster than most. This is a fairly efficient system, and you are not left with the responsibility that you get from a traditional insurance company. You might prefer to call and ask if a claim has been handled, or you could get information on filing your own claims when you work with low-level mental health professionals or clinics that do not file their own claims.

Check Your Insurance Card

You will see all the information for the insurance company on your card, and you could call any number on there including the counseling number. The counseling number is manned at all times because they understand that you could not possibly plan for a medical or mental health emergency. You should look into the things that you have questions about simply by calling the number on your insurance card.

Avoid Office Visits 

You do not need to come to a local office to get the services that you need, and you will find that you could use the phone number to avoid driving around town. You must use the phone number when you are not that mobile, and you could call to get an answer when the office is closed. Be certain that you have called before setting out to visit because some office is hard to get into.