State health insurance assistance program: How they work?

The State Health Insurance Assistance Program (SHIP) provides a grant that is administered by the Administration for Community Living and Office of Healthcare Information and Counseling.

History

In 1990, the Omnibus Budget Reconciliation Act laid the foundation of the State Health Insurance Assistance Program. This law section made state grants by authorizing the Centers for Medicare & Medicaid Services (CMS). The objective of these grants was to help Medicare beneficiaries by developing and maintaining health insurance advisory service programs. The funds for these grants were availed for counseling, supporting information, and assistance operations related to Medicaid, Medicare, and other options of health insurance, such as managed options of care, care insurance of long-term, and Medicare Supplement insurance. In 2014, SHIP was authorized under the Consolidated Appropriations Act and transferred to ACL (Administration for Community Living) from CMS. This transfer shows the existing informal and formal cooperation between the ACL network and SHIP programs.

Purpose of SHIP

The State Health Insurance Assistance Programs provide extensive, unbiased, direct, and free health insurance assistance and counseling to Medicare beneficiaries, caregivers, and their families. SHIPs help people in acquiring coverage through different options such as Medicare Advantage, Medicare Supplement, Medicare Prescription Drug Coverage, and Original Medicare. Beneficiaries with low income are also assisted by SHIP while applying for different programs, like Medicare Savings Program, Low Income/Extra Help Subsidy, and Medicaid, which assist in paying for or reducing healthcare expenses.

This program endeavors to deliver presentations, conduct enrollment events, disseminate information and encourage participation in senior fairs, health fairs, and other events in the community. This program’s outreach assists in informing individuals and groups about Medicare advantages, written forms and notices, appeal procedures and rights, coverage rules, and more.

Functions performed by counselors

The State Health Insurance Assistance Program recruits many counselors and trainees who volunteer to deliver the concerned services. The counselors who take part in SHIP are certified and highly qualified individuals who assist Medicare beneficiaries, their caregivers, and families in the following ways:

  • The counselors provide information about Medicare Prescription Drug Coverage, Medi-gap enrollments or plan comparison, and Medicare Advantage.
  • The counselors explain to Medicare beneficiaries about the potential options for supplemental insurance (insurance policies for retired people) and how they work along with Medicare.
  • Information regarding long-term care insurance is also provided by counselors to the Medicare beneficiaries.
  • Beneficiaries are also referred by counselors to other agencies to acquire additional assistance, such as the State Medicaid offices and the Social Security Administration.
Health Insurance

Structure

There are 54 grantees of the State Health Insurance Assistance Program. The State Departments of Insurance or State Units on Aging deliver the SHIP services along with the National Area Agencies on Aging and other providers of disability and aging services. The grant provided by SHIP fortifies the ability of territories and states to aid a local and community-based network that provides tailored counseling, outreach, and education for achieving the program target. Locally, SHIP encompasses 2,000 sites and 16,000 employees (volunteers, staff, and professionals). Many grantees also provide SMP (Senior Medical Patrol) services other than SHIP services, which assist Medicare beneficiaries in protecting, reporting, and detecting healthcare errors, abuse, and frauds.

The performance of SHIP

A survey was conducted in 2017 to analyze the performance of this program. It was discovered that the State Health Insurance Assistance Program provided direct counseling regarding health insurance to approximately 2,937,160 Medicare recipients, their caregivers, and families. This number also include 446,695 disabled adults. SHIP also outreached to around 3,468,775 people at enrollment events, senior fairs, health fairs, public presentations, and other communal events.

Resources and useful links

The SHIP National Technical Assistance Center (SHIP TA Center) acts as a main national information source for the program. This center provides technical assistance, training, and other resources for supporting SHIPs throughout the nation. People may browse the SHIP National Technical Assistance Centre website for finding out the local SHIP near them and learning more about volunteering, outreach, or counseling opportunities in the community.

www.medicare.gov is the official US government Medicare site. It contains useful tools that beneficiaries can facilitate from, such as MyMedicare and the Medicare Plan Finder.

ACL has developed multiple Volunteer Risk and Program Management (VRPM) policies to help the SHIP and SMP grantees in managing the programs. The policies define the governing values and principles that guide and shape the involvement of team members, set expectations about the volunteer programs management, delineate main expectations of SHIP/SMP team participants and broadly define what team participants might expect from SHIP/SMP. These policies aim to increase the effectiveness, safety, and quality of SHIP/SMP services by providing direction and guidance to SHIP/SMP volunteers and staff.

ACL has also established ‘Conflict of Interest: Identification, Remedy, and Removal’ for managing interest conflicts to provide practical and technical assistance to SMP/MIPPA/SHIP programs. The CBOs (community-based organizations) also facilitate this assistance regarding how perceived and actual COI (Conflicts of Interest) can be avoided and risk can be mitigated.

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