State Health Insurance 

Assistance Program 

(SHIP) 

Report to Congress 

GY 2019 

Prepared by 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Administration for Community Living 

Office of Healthcare Information and Counseling 

1 
 

 

 

 

 

 

 

 

 

 

 

 

 

Contents 

Executive Summary ......................................................................................................................................... 3 

Introduction..................................................................................................................................................... 4 

History ............................................................................................................................................................. 4 

Growing Population and Increasing Service Needs..................................................................................... 4 

2019 Program Performance ............................................................................................................................ 5 

SHIP Performance Data ............................................................................................................................... 5 

Challenges Frequently Reported by People with Medicare ........................................................................ 9 

SHIP Innovations........................................................................................................................................ 12 

Administration Overview............................................................................................................................... 13 

2019 Program Initiatives............................................................................................................................ 14 

Conclusion ..................................................................................................................................................... 16 

Appendix A: 2019 State Health Insurance Assistance Program Grant Awards ............................................. 17 

Appendix B: SHIP Performance Measures & Likert Ratings ........................................................................... 18 

2 
 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary 

The State Health Insurance Assistance Program (SHIP) provides Medicare beneficiaries with information, 

counseling, and enrollment assistance. Its mission is to empower, educate, and assist Medicare-eligible 

individuals, their families, and caregivers to make informed health insurance decisions that optimize 

access to care. SHIPs provide unique, personal, free, and in-depth assistance that is not replicated under 

any other federal program. 

The SHIP program was created in 1990 under Section 4360 of the Omnibus Reconciliation Act (OBRA) 

(Pub. L. 101-508) and is administered by the Administration for Community Living (ACL). In Grant Year 

(GY) 2019, ACL received a discretionary appropriation for $49.1 million. ACL invested these dollars in 54 

grants to states to provide local service to Medicare beneficiaries, staff to support and monitor grantees, 

and administrative support contracts and grants to provide technical assistance, support, and 

continuous improvement for the program. 

During 2019: 

• SHIPs had nearly 2.4 million contacts with Medicare beneficiaries, their families, and 

caregivers, accounting for 1.4 million hours of one-to-one assistance. 

• On average one-on-one counseling sessions covered two complex Medicare topics and took 37 

minutes. 

• SHIPs hosted 61,000 outreach events including interactive presentations, participation in 

community and health fairs, and over 13,000 enrollment events. 

• During the enrollment events, SHIPs assisted roughly 220,000 Medicare beneficiaries, their 

families, and caregivers with plan comparisons. 

This report details SHIP program activities and their impact on beneficiaries during the 2019 grant year 

(April 1, 2019 to March 31, 2020) including a brief history of SHIP, highlights from the 54 SHIP state 

grantees, challenges people with Medicare report to SHIP, and program innovations. Additionally, a brief 

description of administrative initiatives for the 2019 fiscal year (October 1, 2018 to September 30, 2019) 

is included. 

3 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 

The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one 

assistance, counseling, and education to Medicare beneficiaries, their families, and caregivers to help 

them make informed health benefits decisions. ACL provides federal grants to states to fund local 

SHIPs and establish community-based networks of counselors who assist in-person and by phone, 

make group presentations, and use a variety of media sources to educate people with Medicare. 

SHIPs provide unique, personal, free, and in-depth assistance that is not replicated under any other 

federal program. 

The SHIP 2019 fiscal year (FY) actual appropriation was $49.1 million, with $45.5 million provided to 

states and territories for the SHIP State Base Grants. There are 54 SHIP grantees – one in each state, 

the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. Two-thirds of grant recipients 

are State Units on Aging and the other one-third are State Departments of Insurance. 

History 

The SHIP program was created under Section 4360 of the Omnibus Reconciliation Act (OBRA) of 1990 

(Pub. L. 101-508), which authorized the Secretary of the U.S. Department of Health and Human Services 

(HHS) to make grants to States to establish and maintain health insurance advisory service programs for 

Medicare beneficiaries. The grants fund SHIPs to provide direct, local assistance with Medicare 

(including the Original Medicare (Parts A and B) program, Medicare Advantage (Part C), and the 

Medicare Prescription Drug (Part D) program), Medicaid, and other health insurance options, including 

Medicare supplement insurance (also called Medigap), long-term care insurance, and managed care 

options. The complexity of service and amount of funding has varied over the years. 

The recommendations provided in this report are from the SHIPS and do not necessarily reflect the 

official position of the U.S. Department of Health and Human Services. 

Growing Population and Increasing Service Needs 

Over the last decade, the Medicare beneficiary population increased 13% from 54.1 million (2014) to 

61 million (2019). Meanwhile, federal funding for the SHIP program decreased 6% from $52.1 million 

(2014) to $49.1 million (2019). The table below depicts annual federal funding levels since 2014, and 

steady growth in the Medicare population (which is expected to continue to grow). 

Medicare Population and SHIPDiscretionary Appropriation Comparison, 2014-2019 

2014 2015 2016 2017 2018 2019 

Total Federal Funding (millions)* $52.1 $52.1 $52.1 $47.1 $49.1 $49.1 

Funding to State Grantees (millions) $48 $48 $48 $43.5 $44.9 $45.5 

Funding Growth Since 2014 0% 0% -10% -6% -6% 

Medicare Population (millions) 54.1 55.6 57.1 58.5 59.5 61.0 

Medicare Population Annual Growth 3% 3% 2% 1.7% 2.5% 

*Excludes Medicare Patients and Providers Act (MIPPA) funding designated for the SHIPs as that work is outside the scope of 

this report. 

4 
 

 

 

SHIP Federal Funding Compared to Medicare Population, 

2014-2019 

A full list of SHIP grantees and the 2019 Grant Year funding amounts can be found in Appendix A. 

2014 2015 2016 2017 2018 2019 

46.0 

48.0 

50.0 

52.0 

54.0 

56.0 

58.0 

60.0 

62.0 

Total Federal Funding 

(millions) 

Medicare Population 

(millions) 

2019 Program Performance 

SHIPs provide Medicare beneficiaries unbiased information to empower them to make the best health 

care choices for themselves. This section highlights SHIP grantee performance from the 2019 grant year. 

SHIP Performance Data 

SHIPs serve as the main source for Medicare information and assistance in the community. They do so in 

two ways: 1) conducting outreach activities to inform the public about Medicare and other related 

health coverage options; and 2) providing individualized personal assistance to people with Medicare, 

their families, and caregivers (including enrollment assistance). The data that follows is from the SHIP 

Tracking and Reporting System (STARS) for GY2019 (April 1, 2019 – March 31, 2020). 

Beneficiary Contacts Assisted by SHIPs, GY 2017 - 2019 

Outreach & Education 

One-on-One Assistance 

Enrollment Assistance 

0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 

Enrollment Assistance One-on-One Assistance Outreach & Education 

2017 2,386,123 2,937,127 3,468,778 

2018 2,054,426 2,694,195 4,238,927 

2019 1,853,591 2,369,563 3,616,343 

Source: SHIP Performance Measures 1 (Client Contacts), 2 (Outreach Contacts), and 5 (Enrollment Contacts). See Appendix B for 

background on the SHIP Performance Measures. 

5 
 

Medicare Beneficiary Contacts who are "Hard-to-Reach" 

Assisted by SHIPs in GY 2017 - 2019 

Beneficiaries with Limited Incomes 

Beneficiaries in Rural Communities 

Beneficiaries who Speak English as a Secondary... 

Beneficiaries under 65 

Beneficiaries under 65 

Beneficiaries who Speak 

English as a Secondary 

Language 

Beneficiaries in Rural 

Communities 

Beneficiaries with Limited 

Incomes 

2019 330,742 197,340 630,749 809,343 

2018 330,737 250,970 708,665 936,627 

2017 446,693 333,195 634,168 1,077,692 

 

 

 

 

 

 

 

 

 

 

Source: SHIP Performance Measures 3 (Under 65 Contacts) and 4 (“Hard-to-Reach” Contacts as compared to Summary 

Data in STARS). See Appendix B for background on the SHIP Performance Measures. 

SHIPs provide education and counseling to all Medicare beneficiaries, with a special focus on beneficiary 

groups considered “hard-to-reach.” These groups include beneficiaries who are low income, who reside 

in rural communities, and/or are non-native English speakers. Additionally, SHIPs target outreach and 

assistance to beneficiaries under age 65. 

In GY2019, 13,562 SHIP team members (nearly half of whom were volunteers) spent more than 3.5 

million hours helping Medicare beneficiaries understand and make educated choices about their 

healthcare coverage. Every SHIP is required to thoroughly screen, train, and certify each team member, 

including volunteers. Screening, training, and certification must happen before a SHIP counselor can 

work with any Medicare beneficiary. SHIPs are required to use ACL’s Volunteer Risk & Program 

Management Policies1 to support their program management. Each SHIP determines how they will 

create training to meet these standards. The SHIP Technical Assistance Center has an Online Counselor 

Certification Tool which many of the states use for their training and certification. 

Outreach & Education Activities 

SHIPs conduct outreach activities throughout their local communities to educate the public about 

Medicare and help people make informed healthcare decisions. In the 2019 grant year, SHIPs educated 

almost 3.7 million people at more than 61,000 events including in-person presentations, health or senior 

fairs, and enrollment events. Over 12,900 of these events were Enrollment Events which focused on 

providing in-person, one-on-one assistance to help people compare Medicare plans and complete 

enrollment applications. 

1 ACL’s Volunteer Risk & Program Management Policies can be found at https://acl.gov/programs/seniormedicare-patrol/volunteer-risk-and-program-management-vrpm-policies) 

6 
Presentations 

SHIPs conducted approximately 32,500 interactive presentations that reached nearly 1 million 

people. These presentations are tailored to the audience and highlight important dates and 

timely details about Medicare, including the basics of Medicare enrollment, coordination of 

benefits, as well as coverage options and details. SHIPs seek free and low-cost venues for these 

events, which are often held in libraries, community rooms, senior centers, or church event 

spaces. 

Health and Senior Fairs 

SHIPs participated in over 15,800 fairs to raise awareness of their services for people with 

Medicare, their families, and caregivers. In addition to reaching people with Medicare, SHIPs 

often use these opportunities to meet new local partner organizations that can help expand the 

reach of the SHIP services. 

Enrollment Events 

SHIPs hosted nearly 13,000 enrollment events, reaching over 220,000 people with Medicare, 

their families, or caregivers. At an enrollment event, a SHIP counselor meets one-on-one with a 

beneficiary to enter their prescription drugs into the Centers for Medicare & Medicaid Services 

(CMS) Medicare Plan Finder, compare the available plan choices, and discuss the financial 

implications and coverage options. If a beneficiary would like to change plans, the SHIP 

counselor can complete an application on the beneficiary’s behalf through the Medicare Plan 

Finder. However, if the beneficiary wants more time to consider the decision, then they can 

contact the SHIP counselor for enrollment assistance later or contact the insurance plan directly 

to enroll. 

One-on-One Beneficiary Assistance 

In 2019, SHIPs had nearly 2.4 million one-on- one contacts with Medicare beneficiaries, their families, 

and caregivers, providing in-depth information about Medicare benefits and other related healthcare 

questions or issues. These contacts often involve multiple subjects and require extensive counseling and 

assessment to properly address questions and issues. 

The average time spent on one-on-one 

counseling continues to increase annually, 

reflecting the continuous need for and 

complexities of SHIP counseling. It was 28 

minutes in 2014 and 37 minutes in 2019. 

Beneficiaries contact SHIP with unique needs including 

but not limited to the following: 

• Managing benefits when working beyond the age

of Medicare eligibility;

• Coordinating Medicare benefits with employer,

workers compensation, military, or retiree

coverage;

• Completing applications for Medicare coverage or

programs to help pay for Medicare costs; 

• Assisting with claims denials and appeals; and

7 

 

31 

35 

28 29 30 

40 37 

35

30 

25

20

15 

10 

5 

Average Minutes Per SHIP 

Contact, 2014-2019 

Minutes 
 

 

 

 

 

 

 

 

 

 

 

 

 

• Shopping for long-term care insurance. 

On average one-on-one counseling sessions covered approximately two complex Medicare topics. The 

chart below shows the frequency of topics discussed. 

Original Medicare 

Medigap 

Medicare Advantage 

Medicare Part D 

Part D LIS/Extra Help 

Other Prescription Assistance 

Medicaid 

Other Insurance 

Other Topics 

0% 5% 10% 15% 20% 25% 

Frequency of Topic Discussed, GY 2019 

2019 Medicare Open Enrollment 

Since Medicare health and drug plan options change every year, it’s important for Medicare 

beneficiaries to reevaluate their Medicare coverage and plan choices annually during the Medicare 

Open Enrollment Period (October 15 – December 7). Beneficiaries often report challenges with the plan 

review process – related to both understanding changes to their current plan and comparing the other 

options available in their areas. 

Due to the challenges many beneficiaries experience with the annual plan review process, SHIPs spend 

the majority of the Medicare Open Enrollment Period helping people compare Medicare health and 

drug plans. SHIPs help beneficiaries make these comparisons by using the Medicare Plan Finder tool on 

Medicare’s website. However, comparing plans and using the Medicare Plan Finder can be a confusing 

and overwhelming process, particularly for those with low health insurance literacy, limited technology 

skills, limited English proficiency, or who reside in rural areas with poor internet access. Often 

beneficiaries express relief at finding their local SHIP for the clarity the volunteers and staff provide to 

the process. 

On average, time spent with beneficiaries during the 2019 Open Enrollment Period was seven minutes 

higher than during other times of the year. Additionally, the six weeks of Open Enrollment account for 

approximately 30% of the one-on-one counseling sessions for the year. During this time the SHIP 

network focuses primarily on plan comparisons and enrollments. 

8 
 

Comparison of Frequency of Enrollment & Plan Comparison 

Topics Discussed During OEP 2019 to Rest of GY2019 

Medicare Part D Enrollment 

Medicare Part D Plan Comparison 

Medicare Advantage Enrollment 

Medicare Advantage Plan Comparison 

0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 

Medicare Advantage 

Plan Comparison 

Medicare Advantage 

Enrollment 

Medicare Part D Plan 

Comparison 

Medicare Part D 

Enrollment 

Rest of GY 2019 162,691 67,124 225,679 96,102 

2019 OEP 117,228 36,811 358,634 198,873 

The New Medicare Plan Finder Tool 

CMS launched a redesigned Medicare Plan Finder tool in October 2019. The tool was 

modernized and optimized for smart phones and tablets. Additionally, the new website allows 

for a more personalized experience by integrating with beneficiary’s Medicare accounts. This 

allows users to pull their drug lists from their claims data and customized based on their current 

medications. 

SHIP counselors created Medicare accounts for beneficiaries who needed assistance doing so in 

order to allow them to utilize the personalized system. ACL provided guidance to the SHIPs on 

safeguarding usernames and passwords to support the network. SHIP counselors created nearly 

67,000 Medicare accounts during the 2019 Open Enrollment Period which added additional time 

to their counseling sessions. 

As with any new web tool, there were some complications to the roll out which happened to 

coincide with the 2019 Medicare Open Enrollment Period. . CMS implemented multiple 

enhancements shortly after the site was launched in response to feedback received, including 

from the SHIP network. This included an option to sort drug plans based on annual out of pocket 

costs, updating the Low Income Subsidy data, and showing preferred mail order pharmacies. 

Beneficiaries shared that the tool was easy to engage with and understand. SHIPs appreciated 

that CMS was responsive and implemented enhancements when necessary. 

SHIPs recommend CMS make significant enhancements to Medicare Plan Finder well in advance 

of Open Enrollment so that the counselors can be prepared and that there may be fewer 

technical issues during the short six-week period. These recommendations have been 

communicated with CMS. 

Challenges Frequently Reported by People with Medicare 

SHIPs often counsel Medicare beneficiaries who report challenges with Medicare-related processes and 

policies. This section describes some of the challenges reported in this GY2019. In addition, per the 

9 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

authorizing statute, the SHIPs provided ACL with their recommendations for the challenges identified. 

Each of these issues and the associated recommendations are detailed briefly in the section below. 

Aging into Medicare 

Turning 65 is the most common way that people become eligible for Medicare. According to the U.S. 

Census2

, approximately 10,000 people turn 65 every day. Depending on each person’s circumstances, 

they may not be alerted to their initial enrollment period. The SHIPs highlighted two examples of this 

that they have seen frequently. 

Beneficiaries not yet Receiving Social Security Benefits 

Beneficiaries who are already receiving their Social Security benefits will be automatically 

enrolled in Medicare Parts A and B starting the first day of the month they turn 65. However, 

other people turning 65 must contact the Social Security Administration (SSA) three months in 

advance of their birthday to sign up for Medicare. The Nevada SHIP notes that beneficiaries are 

unclear what steps they need to take if any. 

SHIPs recommend that all people turning 65 be mailed information regarding when and how to 

sign up for Medicare, whether they are collecting Social Security benefits or not. 

Transitioning from Medicaid to Medicare due to Age 

The Affordable Care Act gave states the opportunity to expand Medicaid to adults with incomes 

up to 133% of the federal poverty level and a majority have done so. Income eligibility levels for 

this expanded Medicaid adult eligibility group guidelines are often more generous than the 

income guidelines for traditional Medicaid or the Medicare Savings Programs groups. As a 

result, beneficiaries who were enrolled in the expanded Medicaid adult eligibility group may not 

be eligible for additional assistance when they enroll in Medicare and leave the Medicaid adult 

group. SHIPs report the need for additional information to support beneficiaries who are turning 

65 and, therefore, transitioning from the expanded Medicaid adult eligibility group to Medicare 

and may be faced with higher health care costs than they had in the past. Each state varies in 

how they process beneficiaries who are transitioning between these programs. 

SHIPs recommend ongoing education for consumers and health insurance counselors to help 

beneficiaries understand the impact of this transition and what actions they need to take. 

Partnering with the Social Security Administration 

The Social Security Administration (SSA) plays an important role by enrolling beneficiaries in Original 

Medicare (Parts A & B) and administering the Low-Income Subsidy/Extra Help for Medicare Part D. A 

stronger local partnership between the SHIPs and SSA offices would allow them to better serve 

beneficiaries who are looking for Medicare information from SSA. Due to resource concerns, often SHIP 

team members are unable to reach SSA to troubleshoot beneficiary concerns. Additionally, SSA 

representatives are not appropriately trained on all aspects of Medicare or the SHIP program as a 

resource. 

SHIPs recommend national efforts to develop and maintain local relationships with SSA offices. This 

could include: 

https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html 2 

10 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Educating SSA team members about SHIP as a resource and partner to troubleshoot 

beneficiary questions and issues to more fully support beneficiaries. 

2. Referrals for people new to Medicare to SHIPs for education on the program and their 

options. 

3. A dedicated line for the SHIPs to use to connect with SSA to assist with individual beneficiary 

questions and issues. 

4. Coordinating with local SSA field offices to provide space for SHIP team members to serve 

Medicare beneficiaries on-site. 

Medicare Plans Marketing Confusion 

SHIPs report that beneficiaries often contact them asking questions about commercials for Medicare 

insurance products. Often, beneficiaries are confused by what is being offered in the commercials or 

direct mail, and curious what similar benefits their insurance may cover. The Nevada SHIP notes that this 

happens frequently during Medicare Open Enrollment. As a result, SHIP counselors spend a significant 

amount of time answering questions about plans that were advertised but not available to them and 

educating the beneficiaries about what plans are available for them using the Medicare Plan Finder. 

Additionally, the Oklahoma SHIP notes that many insurance companies and agents use the Medicare 

logo which makes it difficult for beneficiaries to differentiate between Medicare and private companies. 

SHIPs recommend better regulation of the commercials and providing clearer guidance on what 

language may be used. This could include: 

1. Educating agents and companies on the current marketing guidelines. 

2. Requiring agents and companies to clearly state their services and the relationship with 

Medicare. 

Medigap Education for Beneficiaries under 65 

SHIPs have seen an increase in clients under 65 who are eligible for Medicare due to a disability or End 

Stage Renal Disease (ESRD). Federal law does not require insurance companies to sell Medigap policies 

to people under the age of 65; however, roughly 30 states require that insurance companies offer at 

least one kind of Medigap policy to beneficiaries under 65. Of these states, some require this for all 

beneficiaries under 65, some for only those eligible due to disability, and others for only those eligible 

due to ESRD. This makes it difficult for beneficiaries to easily compare their coverage options. 

SHIPs recommend coverage options, including Medigap, for beneficiaries under 65 be outlined at the 

federal level to ensure beneficiaries are enrolling in plans that are appropriate for their needs. 

Assistance During Disasters and Public Health Emergencies 

From hurricanes and earthquakes to wildfires and floods, natural disasters continue to tremendously 

impact the SHIP network and the beneficiaries they serve. The Puerto Rico SHIP shared how they are still 

struggling to recover from the devastating hurricanes in 2017 and the earthquake that shutdown the 

power system for the whole island in January 2020. As a result, many SHIP educational services for 

beneficiaries had to be canceled. As grant year 2019 came to a close, the COVID-19 Public Health 

Emergency was declared January 31, 2020 and by mid-March much of the country was shut down. 

SHIPs recommend that clear guidance be provided to beneficiaries impacted by disasters quickly. This 

includes information on possible healthcare coverage and special enrollment periods. 

11 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SHIP Innovations 

SHIPs consistently seek efficiencies and reported these examples of innovative outreach strategies and 

team member training. 

Education and Outreach 

SHIPs continue to look for new ways to find, educate, and enroll beneficiaries. The following are a few 

innovative examples from the network this year. 

Sharing data with state agencies 

Washington SHIP has a data sharing agreement with their state Department of Licensing (DOL). 

The DOL gives the SHIP a list of residents turning 65 by zip code. They use the list to send 

targeted outreach materials for those turning sixty-five and invite them to attend local 

educational events. 

Partnering with media outlets for public education 

Hawaii and North Carolina SHIPs shared innovative partnerships developed with media outlets 

to provide public education. 

• Reaching beneficiaries through cable - A division of Charter Communications, 

SPECTRUM is the largest service provider of cable and internet in Hawaii, reaching 

86% of households. SPECTRUM was hired by Hawaii SHIP to create public service 

announcements (PSAs) on the Medicare open enrollment period, volunteer 

recruitment, and branding awareness of Hawaii SHIP’s services. The PSAs feature 

three prominent Hawaii citizens, whose contributions to local sports and the 

University of Hawaii (UH) were celebrated: retired women’s basketball coach Vince 

Goo, retired sportscaster Jim Leahy, and retired women’s volleyball coach Dave 

Shoji. Overall statewide recognition of Hawaii SHIP and volunteer recruitment has 

increased with the launch of these PSAs. 

• Reaching beneficiaries while they wait - North Carolina SHIP contracted with the 

Motor Vehicle Network (MVN) to reach a highly focused audience of Medicare 

beneficiaries, their families, and caregivers in the 111 local offices across the 

state. The MVN broadcasts news, information, and entertainment via satellite onto 

large format, high definition flat screen televisions that are strategically placed 

inside Department of Motor Vehicles (DMV) offices which informs thousands of 

local residents who are waiting to complete transactions inside the DMV. Nearly 4 

million people visit a DMV office in NC each year, and visitors typically have to wait 

for an hour or longer with each visit. Three 30-second digital advertisements were 

produced using NC SHIP’s logo and messaging to highlight Extra Help, Medicare 

Questions for those 65+ and under 65 due to disability, and the Opioid crisis with 

Operation Medicine Drop. The ads repeated every 15 minutes on each screen in the 

DMV offices during visitor hours providing a total exposure of 32 times per day. 

Partnering with religious communities 

Mississippi SHIP’s “I Care So I Share” initiated a plan to engage faith-based communities to share 

Medicare informational resources. SHIP state leaders reached out to the heads of religious 

conventions asking them to share Medicare information among their congregations. They 

established a relationship with the General Missionary Baptist State Convention of Mississippi, 

12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inc. The SHIP presented the idea of establishing SHIP volunteers at each church to 130 pastors 

at their winter meeting. 

Educating public health and social work students 

Hawaii SHIP created an “Intro to Medicare” course in partnership with University of Hawaii at 

Manoa’s Schools of Public Health and Social Work (PH/SW). The goals for the course are to 1) 

expand student’s awareness of Hawaii SHIP, 2) encourage students toward careers in 

gerontology, 3) increase volunteers by onboarding and certifying students, 4) impart the value 

of volunteering, and 5) utilize student’s reflections, products, papers, and presentation to 

inform future program planning strategies. The curriculum stems from the trainings used in 

Hawaii SHIP’s Medicare 101, 201, and 301 courses for volunteers, utilizing the curriculum from 

the SHIP TA Center. PH/SW’s curriculum boards approved the curriculum in Spring 2019. The 

graduate course launched in the Spring 2020 semester with the first class starting on January 

17th. 

Staff Training and Resources 

SHIPs spend hours developing and training team members on the complexity of Medicare. Highlighted 

below are a few examples of innovations on this topic from Grant Year 2019. 

Going paperless and increasing efficiency 

The Florida SHIP created a comprehensive online training program which has increased 

volunteer efficiency and decreased program costs by making the program essentially paperless. 

This online training program has an external public facing side and an internal secured volunteer 

side. On this website you can fill out the online volunteer application, watch the online 

Orientation Training module, find counseling sites, upcoming events, and Program fact sheets. 

Training partner agencies to support beneficiaries 

Texas SHIP provides an annual state-wide benefits counselor training and conference with 

themes, such as “Let’s All Get in SHIP Shape” and “Navigating for Smooth Sailing.” The 

conference presents the attendees with continued educational training on new and existing 

information regarding Medicare and Medicaid-related services and supports, state and 

community partnerships, volunteerism, programmatic procedures, and opportunities to 

strengthen and develop partnerships with their peers. The annual training includes 

representatives from various state agencies and community organizations providing education 

on SHIP-related topics. 

Administration Overview 

The SHIP discretionary appropriation was $49.1 million in 2019, with $45.5 was provided to 54 states 

and territories for the SHIP State Base Grants. The remainder was used to fund the following existing 

commitments, administrative costs, and the SHIP Technical Assistance Center used to support the 

SHIP network (more details on each is provided on the pages following): 

• SHIP Technical Assistance Center: A single cooperative agreement awarded to the North East 

Iowa Area Agency on Aging to provide technical assistance, training, and resources to the SHIP 

grantees to support the national network. This grant is in Budget Year 3 of 3. 

13 
 

 

 

 

 

 

 

 

 

• SHIP/Senior Medicare Patrol (SMP) Joint Conference Logistics: Synergy Enterprises Inc. was 

contracted in FY 2016 to provide SMP/SHIP grantee training conference logistics for four 

years. The third year was awarded in FY 2019. 

• SHIP/SMP Beneficiary Survey: The vendor, CG Strategies, provides oversight and management 

of a national survey used with Medicare beneficiaries served by SHIP and SMP programs to 

determine satisfaction and accuracy of the services provided. In FY2019, ACL entered the 4th 

year of this contract. 

• SHIP Tracking and Reporting System (STARS): Booz Allen Hamilton was contracted in FY 2016 

to develop the new data system, then provide operational support and maintenance to 

support the SHIP and Medicare Improvement for Patients and Providers Act (MIPPA) 

programs. In FY 2019 this contract was extended in order to synchronize activities and 

provide continued data analysis to the SHIP network. 

• SHIP National Performance Reporting (NPR) System: Technical Frontiers, Inc. provides the 

data system support and oversite for the old SHIP reporting system. In FY2019, ACL extended 

the contract by three months to complete the close out of the contract and transition the 

state grantees from this system into the new STARS system. 

• Administrative and Program Support Costs: salaries and benefits; overhead/rent; travel, 

training, and conferences; grant systems; and IT hosting. 

2019 Program Initiatives 

The SHIP Program is administered by ACL’s Office of Healthcare Information and Counseling (OHIC), 

which also oversees the Senior Medicare Patrol (SMP) and Medicare Improvements for Patients and 

Providers Act (MIPPA) programs. The SMP program provides outreach and education to Medicare 

beneficiaries to prevent, detect, and report Medicare fraud, errors, and abuse. The MIPPA program 

provides grants to states and tribes to help older adults, individuals with disabilities, and their caregivers 

apply for special assistance through Medicare. Since many of the SHIP programs are co-located with 

SMP and MIPPA, often ACL Program Initiatives span all three programs. 

This grant year, ACL continued with initiatives to support the work grantees are doing. This includes 

communications and stakeholder engagement; technical assistance to grantees; and program 

evaluation. 

Communications and Stakeholder Engagement 

The SHIPs provide detailed and in-depth one-on-one assistance to Medicare beneficiaries in local 

communities across the country. The successful continuation of these activities requires a strong 

partnership with the Centers for Medicare & Medicaid Services (CMS) to provide technical assistance, 

support, and communication to the SHIPs on Medicare, Medicare changes, and beneficiary issues and 

questions. ACL participates with CMS and other Federal partners in a number of workgroups to ensure 

SHIPs receive timely Medicare and other relevant healthcare related updates. These workgroups also 

provide an opportunity for ACL to share SHIP and Medicare beneficiary experiences and successes, as 

well as challenges that are brought to the SHIPs, which may help inform federal partner decisions. 

14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Technical Assistance to SHIP Grantees 

ACL provides technical assistance to SHIP grantees through direct support from ACL staff and the award 

of grants and contracts that provide additional resources for grantees. 

Support from ACL Staff 

SHIP programmatic dollars fund ACL Project Officers to work closely with SHIP grantees to help 

them understand ACL’s policies and priorities, as well as how to properly oversee and manage 

their federal grants. Project Officers communicate with SHIP grantees regularly via email, 

webinars, and monthly conference calls to discuss SHIP questions and concerns, talk through 

any challenges, and identify promising practices that could be shared with the broader SHIP 

grantee network. ACL staff consult with SHIPs to develop solutions to emerging issues, as well as 

review and provide feedback on programmatic progress reports. 

In addition to collaboration and monitoring, ACL staff manage several projects aimed at 

enhancing availability of SHIP services, including the SHIP Technical Assistance Center, SHIP data 

system, SHIP customer satisfaction survey, and SHIP national training meeting (all described 

below). 

SHIP Technical Assistance Center (SHIP TA Center) 

SHIP programmatic dollars fund the SHIP TA Center, which serves as a central resource for 

disseminating knowledge and best practices to SHIP grantees. The SHIP TA Center also provides 

ongoing support and information for SHIPs on issues and trends in Medicare, Medicaid, and 

volunteer management; develops new products and tools for the national SHIP network, 

including fact sheets and training manuals; and provides technical assistance to SHIP grantees 

through webinars, one-on-one assistance, and written instructions. The SHIP TA Center draws 

upon wide-ranging resources to respond to a rapidly changing programmatic environment and 

the issues associated with the national network that provides services and supports to older 

adults and people with disabilities in their homes and communities, Medicare, and the broader 

health insurance industry affecting Medicare beneficiaries. 

SHIP Data System 

The SHIP Tracking and Reporting System (STARS) is the reporting and data analysis tool the 

SHIPs use for their program management. The system allows ACL and the grantees to determine 

whether SHIPs are meeting the goals set forth by the agency and in the authorizing legislation. 

STARS also provides a connection with the Senior Medicare Patrol’s (SMP) data system, so the 

systems can share data. This increases efficiencies at the local level, since the same grantees and 

counselors complete much of the work. 

SHIP Customer Satisfaction Survey 

SHIP programmatic dollars fund the administration of a SHIP Customer Satisfaction Survey. The 

goals of the survey are to measure satisfaction with SHIP Medicare counseling services, to assess 

how customers value the services and information they receive, to identify opportunities for 

continuous improvement, and to comply with regulatory requirements regarding data 

collection. Implementation of the survey began August 2017 and will conclude August 2020. 

Approximately one third of the states will be surveyed during each year of implementation with 

all covered by the project at the end of the 3-year cycle. The final report will provide an 

overview of the national results with state specific findings. 

15 
 

 

 

 

 

 

 

 

 

 

 

 

While the study is still under way, the years 1 and 2 preliminary results showed that 87% of 

respondents were satisfied with the counseling services they received. The chart below displays 

additional preliminary findings about customer satisfaction with SHIP counseling: 

Question Text Average 

Score 

Percent who “Agreed” 

or “Strongly Agreed” 

I was able to find and contact 

Q4 SHIP in a timely fashion. 4.27 89% 

Q6 The information provided to 

me was accurate. 

4.27 87% 

SHIP provided me with useful Q7 information. 4.30 88% 

Q9 Overall, I was satisfied with 

my interaction with SHIP. 4.32 87% 

I would contact SHIP again for Q10 assistance. 

4.38 90% 

Q11 

I would recommend SHIP’s 

service to others. 4.38 89% 

SHIP National Training Meeting 

ACL hosts a national training for SHIPs and SMPs annually. The purpose of the conference is to 

assist, support, and inform the program directors and their support staff nationwide. The 

meeting offers an opportunity to review core values and practices that define the programs, yet 

also hone new skills to strengthen the programs’ outreach efforts and the involvement of 

volunteers. This meeting also allows states to network and share information related to best 

practices with SHIP and SMP grantees in other states. In addition to grantees from other states, 

attendees are provided an opportunity to meet ACL staff, national partners like CMS and the 

National Council on Aging, and the SHIP TA Center staff. 

During this reporting period the conference was held in San Diego July 22 - 25, 2019. Over 300 

people attended this conference. Presenters included staff from ACL, CMS, HHS-OIG, other 

national partners, and SHIP and SMP staff. Major topics included grants management, outreach, 

volunteer training, data reporting, reaching specific populations, and Volunteer Risk and 

Program Management policies. 

Conclusion 

SHIPs provide unique services to Medicare beneficiaries to help them make the best choice for their 

health care coverage. The 54 SHIP grantees serve as the main source for Medicare information and 

assistance in the community. They provide individualized personal assistance to people with Medicare, 

their families, and caregivers; and conduct outreach activities to inform the public about Medicare and 

other related health coverage options. Because of this service, beneficiaries often report relief after 

counseling sessions with the SHIP counselors. As the population of the United States grows older, SHIP 

services will continue to be a vital resource to help older Americans navigate the complexities of 

Medicare. 

16 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A: 2019 State Health Insurance 

Assistance Program Grant Awards 

Project Period April 1, 2019 – March 31, 2020 

Total Awards: $45,536,953 

State FY 2019 Award 

Alabama $837,434 

Alaska $224,399 

Arizona $830,235 

Arkansas $592,198 

California $4,269,535 

Colorado $594,554 

Connecticut $533,378 

Delaware $198,553 

District of Columbia $150,886 

Florida $2,729,528 

Georgia $1,131,535 

Hawaii $245,383 

Idaho $379,783 

Illinois $1,496,800 

Indiana $857,722 

Iowa $676,033 

Kansas $514,445 

Kentucky $829,500 

Louisiana $651,368 

Maine $426,541 

Maryland $726,655 

Massachusetts $925,981 

Michigan $1,426,134 

Minnesota $912,876 

Mississippi $584,956 

Missouri $903,877 

Montana $546,634 

State FY 2019 Award 

Nebraska $407,949 

Nevada $403,942 

New Hampshire $280,112 

New Jersey $1,026,719 

New Mexico $423,698 

New York $2,316,502 

North Carolina $1,454,853 

North Dakota $246,172 

Ohio $1,723,085 

Oklahoma $597,669 

Oregon $570,617 

Pennsylvania $1,939,131 

Rhode Island $264,254 

South Carolina $751,982 

South Dakota $307,414 

Tennessee $1,056,654 

Texas $2,581,709 

Utah $347,761 

Vermont $236,464 

Virginia $987,212 

Washington $869,459 

West Virginia $461,101 

Wisconsin $894,229 

Wyoming $284,876 

Guam $47,043 

Puerto Rico $812,380 

Virgin Islands $47,043 

17 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix B: SHIP Performance Measures & Likert Ratings 

SHIPs are evaluated on the following Performance Measures (PM): 

Performance Measure 1: Client Contacts - Percentage of total one-on-one client contacts (inperson, by phone, by e-mail, postal mail, or fax) per Medicare beneficiaries in the State. 

This performance measure covers every one-on-one interaction SHIPs have with beneficiaries or 

on behalf of a beneficiary. It includes in-person counseling sessions (in the office or at the 

beneficiary's home); telephone conversations of all durations (including on-line call formats such 

as Skype); and email, postal mail and fax correspondence. It does not count unsuccessful 

attempts to reach beneficiaries (such as leaving messages); individuals reached through public 

events (unless the presenter has substantial individual interaction with a beneficiary after the 

event); contacts when the only purpose is to schedule a meeting; or mass emails. 

Performance Measure 2: Outreach Contacts - Percentage of persons reached through 

presentations, booths/exhibits at health/senior fairs, and enrollment events per Medicare 

beneficiaries in the State. 

This performance measure is the number of people reached through presentations (including 

webinars and tele-conferences), booths/exhibits at Health/Senior Fairs or Special Events, and 

Enrollment Events. The event must include the provision of Medicare or SHIP information to the 

public. In order to count outreach contacts SHIPs must have the ability to monitor attendance 

and provide an opportunity for participants to ask questions and provide clarification at the time 

of the presentation. 

Performance Measure 3: Contacts with Medicare Beneficiaries under 65 - Percentage of 

contacts with Medicare beneficiaries under the age of 65 per Medicare beneficiaries under 65 

in the State. 

This performance measure includes the number of one-on-one contacts with Medicare 

beneficiaries who are under the age of 65. The beneficiary must be receiving or applying for 

Medicare and Social Security benefits due to a disability or; receiving Medicare because of the 

diagnosis of End-Stage Renal Disease. This does not include soon-to-be new to Medicare 

beneficiaries (i.e. those entering Medicare at age 65). 

Performance Measure 4: Hard-to-Reach Contacts - Percentage of low-income, rural, and nonnative English contacts per total "hard-to-reach" Medicare beneficiaries in the State. 

This performance measure is based on the number of contacts made with any of the designated 

hard-to-reach populations divided by the total number of beneficiaries in that population. The 

designated hard-to-reach populations include: 

o Low-income beneficiaries - all contacts with beneficiaries whose income is below 150% 

Federal Poverty Level; 

o Rural beneficiaries - all contacts with beneficiaries that live in areas with a population 

fewer than 50,000 as designated by the Office of Management and Budget (OMB), and; 

o Non-native English speaking beneficiaries - all contacts with beneficiaries where English 

is not the beneficiaries first language. 

18 
Performance Measure 5: Enrollment Contacts - Percentage of unduplicated enrollment 

contacts (i.e., contacts with one or more qualifying enrollment topics) discussed per total 

Medicare beneficiaries in the State 

This performance measure is the total unduplicated enrollment contacts as reported on the 

SHIP client contact form. It includes eighteen possible enrollment topics, such as assistance with 

enrollment in Medicare Part D plans, Medicare Advantage, the Low-Income Subsidy and 

Medicare Savings Programs. 

Below are the national performance measure results from April 1, 2019 – March 31, 2019: 

PM 1: Client Contacts – 2,369,563 Beneficiary Contacts (3.86% of eligible population) 

PM2: Public Media Outreach Contacts – 3,616,343 Beneficiary Contacts (5.88% of eligible 

population) 

PM 3: Medicare Beneficiaries Under 65 Contacts – 278,747 Beneficiary Contacts (3.26% of 

eligible population) 

PM 4: Hard-to-Reach Contacts – 1,637,432 Beneficiary Contacts (4.13% of eligible population) 

PM 5: Enrollment Contacts – 1,853,591 Beneficiary Contacts (3.02% of eligible population) 

Additionally, ACL creates a Likert Rating for the grantees to provide them with an understanding of how 

they compare with their peers. Each grantee receives a Likert rating for each PM based on last grant 

year’s performance and a target Likert rating for each PM to work towards in this year’s grant year. 

These ratings are shared with the SHIP network, which allows them to identify which states they can 

approach when they are looking for ideas for improvement. 

The scale for each PM breaks down as follows: 

• Top 10% (5 States): Excel lent

• Next 20% (11 States): Good 

• Middle 40% (22 States): Average 

• Next 20% (11 States): F air 

• Bottom 10% (5 States): Low 

The ratings for this grant year follow. 

19 
20 
21 
22 
23 
24