How
to Answer Your Patient’s Medicare Questions
Health
Insurance Counseling is Available Via SHIPS
SHIPS:
(State Health Insurance Counseling
and Assistance Programs)
AS THE government has
increased Medicare choices, Medicare has become more and more
complex. Luckily, the federal government also supplies a source of
advice: the State Health Insurance Counseling and Assistance
Programs, called the SHIP programs. These programs provide free
insurance help and information in person or by phone to people on
Medicare and to their caregivers.
SHIP
Programs Vary From State To State
Although funded by the
federal Centers for Medicare and Medicaid Services (CMS), the SHIP
programs are administered by each individual state. Usually, the
program is housed in the department or office of insurance or aging.
Nationwide, over 1,000 organizations help sponsor SHIP
programs. Generally, the counselors are trained volunteers.
States put their own
stamp on their SHIP programs. In fact, even the name varies from
state to state. South Dakota calls its program Senior Health
Information and Insurance Education (SHIINE), for example. whereas
New York’s program is called the Health Insurance Information,
Counseling and Assistance Program (HIICAP).
CMS has set certain
stanlards for the SHIP programs and encourages SHIP programs to
strive to meet certain quality goals. However, programs in different
states originated in different ways and have different cosponsors.
As a result, some programs do not yet meet all the CMS standards.
And because people from different states have different needs,
services vary. For example, Arizona’s SHIP program translated materials
on end-stage kidney disease into a Southwestern Native American
language; such materials would not be useful outside that region.
Federal guidelines
require SHIP programs to provide free insurance counseling to anyone
on Medicare. “Anyone” include people under 65 who are on
Medicare because they are disabled or have end-stage kidney
disease. However, some states’ SHIP programs started as programs
for the elderly and have not yet expanded their services to everyone
legally entitled to them.
What
SHIPS Do
Examples of the kinds
of questions your state SHIP program can help with are:
• What Medigap plans
are avail able in your state?
• Do you need a
Medigap policy? If so, which one is best for you?
• Medicare
wouldn’t pay for one of your medical bills. Should it have?
• How can you appeal
a payment denial?
• Can you get any
help from your state in paying your Medicare premiums?
• Do you need
long-term care insurance?
• What are the
differences between original Medicare and MedicarePlusChoice?
• What are the
differences among health-maintenance organizations, preferred
provider organizations, and other MedicarePlusChoice programs?
• What do the
various items on your Medicare bill mean?
• How can you
organize all your medical paperwork?
• Choosing
a managed care plan
•
Deciding between
original Medicare (fee-for-service) and managed care
•
Understanding your new
health plan choices.
• How to
understand your Medicare bill.
• How/whether to purchase additional health insurance (Medigap
policy, long-term care insurance, etc.).
• Understanding your Medicare rights/protections and how to
submit a complaint about medical care or treatment.
In addition to
one-on-one help, some SHIP offices also offer brochures or other
written information on understanding health care. SHIP offices can
refer people to other sources of help, such as social services or
legal services.
SHIP programs do not
sell insurance and they have no links to any insurance company. The
information they provide is meant to be independent and unbiased.
Finding
Your State’s Program
The last page in this
feature lists Web addresses for SHIP administrators in almost
every state. For the most up-to-date version of this list, go to
www.medicare.gov/ Contacts/Related/Ships.asp.
To get a phone number;
go to www. medicare.gov/Contacts/ Home.asp or http://hiicap.state .ny.us/home/link08.htni.
If you do not have Web access, call 1-800-MEDICARE or look at the
back of the Medicare handbook (“Medicare & You”) for the
current year. (The Medicare handbook is available online, or you can
call the phone number listed above and request it.)
SHIP PROGRAMS
State Health Insurance
Counseling and Assistance Programs (SHIP Programs)
The
following is a listing of website addresses Medicare provides for
state offices, departments, and organizations that administer State
Health Insurance Counseling and Assistance Programs (SHIPS).
Be aware that some of these addresses do not take you
directly to the SHIP information and you man have to hunt around for
it.
Your
Local SHIP Office:
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